Malignant idiopathic anaphylaxis

A patient with idiopathic anaphylaxis (IA), classified as generalized IA with frequent episodes, had original episodes in 1985 and has been managed and studied by the authors since 1987. Although her episodes of IA appear to have been controlled by prednisone, progressively larger doses of prednisone have been required. The patient was classified as a patient with corticosteroid-dependent IA, a subset of patients with IA in whom a remission cannot be induced with prednisone and in whom prednisone cannot be stopped. A trial of ketotifen is in progress without definitive effect on prednisone requirement. Because this corticosteroid-dependent patient with IA, which is potentially fatal, cannot be managed on less than 90 mg of alternate-day prednisone, we propose the term malignant IA to categorize such severe cases of IA.

Effects of an experimental program on post-hospital adjustment of early discharged patients

This paper reports the results of a study evaluating the effects of an experimental program on post-hospital adjustment of early discharged patients after total hip arthroplasties. This experimental program consisted of patient teaching by means of a pamphlet and videotape, and regular home visits by a community health nurse. A significant difference was found between the experimental and control patients in perceived preparedness for discharge and post-hospital exercise compliance. The early discharged experimental patients demonstrated post-hospital objective and subjective functional capabilities equal to those of the control patients. This study is seen to have implications for nursing service and nursing education.

Postpartum retinal detachment. A case report

A postpartum progression of preeclampsia ultimately resulted in bilateral serous retinal detachment.

Properties and applications of photodynamic therapy

Photodynamic therapy (PDT) is the treatment of malignant lesions with visible light following the systemic administration of a tumor-localizing photosensitizer. Pharmacological and photochemical properties of the photosensitizer are combined with precise delivery of laser-generated light to produce a treatment which can offer selective tumoricidal action. Hematoporphyrin derivative (HD) and a purified component called Photofrin II are currently being used in clinical PDT. Initial patient results have been encouraging, and considerable interest has developed in the synthesis and evaluation of new photosensitizers with improved photochemical and pharmacological characteristics. In addition, there has been a gradual increase in knowledge related to in vitro and in vivo mechanisms of action of PDT. This report provides an overview of the properties and applications of PDT. Information and data related to drug development, photochemistry, subcellular targets, in vivo responses, and clinical trials of PDT are presented.

Contribution of permeability and sensitivity to inhibition of DNA synthesis in determining susceptibilities of Escherichia coli, Pseudomonas aeruginosa, and Alcaligenes faecalis to ciprofloxacin

To examine the correlation between bacterial cell susceptibility to ciprofloxacin and the magnitude of uptake and cell target sensitivity, the relative contribution of ciprofloxacin accumulation in intact cells and its ability to inhibit DNA synthesis were investigated among strains of Escherichia coli, Pseudomonas aeruginosa, and Alcaligenes faecalis. Uptake studies of [14C]ciprofloxacin demonstrated diffusion kinetics for P. aeruginosa and E. coli. Ciprofloxacin was more readily removed from E. coli J53 and A. faecalis ATCC 19018 by washing than from P. aeruginosa PAO503. These results indicate that the process of cell accumulation is different for P. aeruginosa in that the drug is firmly bound at an extracellular site. Whatever the washing conditions, A. faecalis accumulated less drug than either of the other two bacteria. Magnesium chloride (10 mM) caused a substantial decrease of ciprofloxacin accumulated and an increase in the MIC, depending upon the nature of the medium. The addition of carbonyl cyanide m-chlorophenylhydrazone caused a variable increase in drug accumulated, depending on the medium and the bacterial strain. The concentration of ciprofloxacin required to obtain 50% inhibition (ID50) of DNA synthesis for P. aeruginosa PAO503 and A. faecalis ATCC 19018 did not correlate with their corresponding MICs but did for E. coli J53. Treatment with EDTA decreased the ID50 of ciprofloxacin for P. aeruginosa PAO503 and its gyrA derivative by 5- and 2-fold, respectively, and decreased the ID50 for E. coli JB5R, a strain with a known decrease in OmpF, by 1.4-fold but did not decrease the ID50 for the normally susceptible E. coli J53. The ID(50) for P. aeruginosa obtained after EDTA treatment or in ether-permeabilized cells was higher than that obtained for the other two strains. The protonophore carbonyl cyanide m-chlorophenylhydrazone prevented killing by low ciprofloxacin concentrtaions, but sodium azide did not. The latter compound did not enhance killing in association with inhibition of a previously described energy-dependent efflux of ciprofloxacin susceptibility being the susceptibility to inhibition of DNA synthesis in E. coli, poor premeability associated with the small pore size of A. faecalis, and a combination of low permeability and reduced susceptibility of DNA synthesis to inhibition for P. aeruginosa.

Psychosocial factors influencing outcome in patients with low-back pain

A psychosocial analysis of 58 patients with low-back pain was conducted. Three groups of patients with different outcomes were delineated with distinctly different psychosocial profiles. Patients who recovered uneventfully had a better income, reported more satisfaction with hospitalization or medical personnel, and had prolonged pain-free periods. Patients with the worst outcomes in terms of poor work role adjustment and severe pain complaints were more likely to be immigrants from mainland China, to be engaged in heavy manual labor, to be involved in compensation claims for work-related injuries, manifested a high degree of anxiety and depressive symptoms, and were hostile toward medical personnel. An intermediate group of patients with adequate work role adjustment but severe to moderate levels of pain were characterized by being females with varying combinations of anxiety and depressive symptoms. A preliminary clinical interview guide for screening potential problematic patients was developed.

Quinolone antimicrobial agents: mechanism of action and resistance development

The primary target of fluoroquinolone antimicrobial agents is the A subunit of DNA gyrase. In several cases a close relationship to ID50 (inhibitory dose-50%) and minimum inhibitory concentration (MIC) has been shown for gram-negative bacteria, although this has not been regularly observed for gram-positive bacteria to date. Cellular entry is by means of diffusion and involves, at least in part, the porin pathway in the outer membrane of gram-negative bacteria. An energy dependent efflux occurs which is more active in brain heart infusion broth than nutrient broth and which, to date, has not been shown to contribute to inhibition of growth or bacterial lethality. The extent of uptake by different gram-negative bacteria varies and may contribute in some cases to determination of the MIC. Resistance to fluoroquinolones is by means of mutations affecting the gyrase gene coding for the A subunit and mutations which affect cell permeability particularly involving porin proteins of the outer membrane. Combined target and permeability resistance has been reported but involves two or more mutational steps. Resistance during clinical treatment has been observed, but is most likely to be of low magnitude and to be detected in patients with significantly compromised host defenses.

Endogenous Nocardia asteroides subretinal abscess diagnosed by transvitreal fine-needle aspiration biopsy

The authors report a case of an endogenous Nocardia asteroides subretinal abscess in an immunosuppressed cardiac transplant recipient. On clinical grounds, the metastatic subretinal abscess was initially thought to be a fungal, atypical bacterial, or viral lesion. Transvitreal fine-needle aspiration biopsy of the lesion yielded a sufficient specimen for immediate preliminary identification of the microorganism and permitted prompt initiation of an appropriate antibiotic regimen. The definitive diagnosis was based on culture of the organism from the needle aspirate.

Effect of tolmetin glycine amide (McN-4366), a prodrug of tolmetin sodium, on adjuvant arthritis in the rat

The glycine amide of tolmetin sodium (TGA) functions as a prodrug and was demonstrated to be more potent than the parent compound as an inhibitor of developing and established adjuvant arthritis in the female Lewis rat. In contrast, the glycine amide of indomethacin was less potent than indomethacin. The superiority of TGA relative to tolmetin sodium in alleviating this condition was demonstrated by inhibition of paw swelling and reduction of the degenerative bone changes that are associated with the progression of this chronic animal model of rheumatoid arthritis in humans. These properties were not evident when equimolar mixtures of tolmetin sodium and glycine were administered concurrently. Pharmacokinetic analyses revealed that TGA was absorbed completely and hydrolyzed to tolmetin in the female adjuvant arthritic rat. The combined effects of absorption, distribution and hydrolysis of TGA produced lower peak plasma tolmetin levels than an equivalent dose of tolmetin sodium, but plasma concentrations were sustained for a longer period of time contributing to an apparent increase in potency. Furthermore, TGA displayed a decreased propensity to cause gastrointestinal irritation compared to tolmetin sodium. Several additional amino acid amides of tolmetin were similar to the glycine amide in exhibiting increased potency and reduced gastrointestinal toxicity in comparison to equivalent doses of tolmetin sodium.

Low dose postoperative adjuvant radiation therapy for rectal cancer is ineffective

Ninety-seven patients with rectal cancer which had either penetrated through the rectal wall or involved regional lymph nodes received postoperative adjuvant radiation therapy of 24 Gy in 12 fractions or 25 Gy in 10 fractions in 2 weeks. The crude pelvic recurrence rate was 48/97 (49%) and the actuarial local relapse-free rate at 5 years was 41%. The radiation doses used produced no late morbidity, but had no discernible effect on the risk of local recurrence, and may have compromised the subsequent use of radiation for symptomatic pelvic recurrence.

Is Hare's Psychopathy Checklist reliable without the interview?

The assessment of criminal psychopathy using the Psychopathy Checklist of Hare is based on a file review and a structured interview. However, the inmate may not always be accessible for the interview and researchers may have to rely on ratings obtained through a comprehensive file review alone. The present study investigates the reliability of ratings based on file review alone. Psychopathy Checklist ratings for 56 subjects were obtained with and without the structured interview. Reliable ratings on the Checklist and accurate classification of inmates were obtained without the interview. Ratings obtained without the interview tended to give a slightly more conservative estimate of the size of the group high in psychopathy.

Metal-dependent binding of a factor in vivo to the metal-responsive elements of the metallothionein 1 gene promoter

Using the technique of genomic footprinting, we demonstrate cadmium-inducible protection from dimethyl sulfate (DMS) modification of guanine residues in vivo in five metal-responsive elements (MREs) in the promoter of the rat metallothionein 1 (MT-1) gene. We also identify a site of extreme DMS hyperreactivity which, like the MRE protection, occurs only after metal ion induction. With this hyperreactive site as an indicator, we can measure the kinetics of induction and deinduction. Changes in the intracellular metal ion concentrations are reflected in alterations in the reactivity with DMS of guanine residues in the MT-1 gene promoter. Lastly, for both control and metal-induced cells, we observe DMS protection and enhancement of a binding site (located 5' of the distal MRE) which is a consensus sequence for the Sp1 transcription factor. Transfection experiments with deletion mutations of a fusion gene construct indicate both that a sequence region which includes this GC box regulates the basal level of expression of the MT-1 gene and that increasing the number of MREs in the promoter increases the induced level of transcription. Our genomic footprinting and transfection data together suggest that (i) a transcription factor, possibly Sp1, plays an important role in regulating the basal level of expression of the MT-1 gene and (ii) metal induction involves the metal-dependent binding to a sequence-specific binding factor which responds to changes in intracellular metal ion levels.

Accumulation of enoxacin by Escherichia coli and Bacillus subtilis

Several methods were used to determine enoxacin uptake in Escherichia coli strains because washing of cells removed all or most cell-associated enoxacin whereas no washing was associated with large amounts of cell-bound enoxacin. Washing after up to 40 to 45 min of exposure to enoxacin followed by suspension in drug-free medium prevented a significant effect of enoxacin on cell growth. Cell uptakes obtained with different methods showed no difference in the shape of the timed uptake curves but did show significant quantitative differences. These results are consistent with cell-associated enoxacin comprising a freely exchangeable pool of drug. Lineweaver-Burk plots of uptake were consistent with uptake of enoxacin by simple diffusion. No saturability and no competition with ciprofloxacin were observed. Low temperature (4 degrees C) was associated with decreased uptake. Arsenate, carbonyl cyanide m-chlorophenylhydrazone, sodium fluoride, sodium azide, and 2,4-dinitrophenol had no effect on uptake. We conclude that the mechanism of transport of enoxacin into cells is by simple diffusion. Mutants of E. coli with deficiency of outer membrane proteins F and C and an enoxacin-resistant mutant selected by serial passage with increasing enoxacin concentrations demonstrated that F porins play a significant role in enoxacin uptake and influence susceptibility to enoxacin. Uptake was shown to be similar in a strain of Bacillus subtilis.

Towards effective clinical teaching in nursing

During the last two decades, the structure and function of clinical learning and teaching have undergone significant changes. Nursing students demand quality teaching rather than supervision in the clinical area alone. At the same time, expectations and demands of university nursing faculty also change. Nurse educators are under increasing pressure to engage in scholarly activities. Clinical instruction in baccalaureate nursing programmes becomes the primary responsibility of either the inexperienced or part-time, sessional instructors. This pattern of faculty teaching assignment is not without problems. This paper critically examines these problems and proposes strategies for dealing with them.

Eicosapentaenoic acid inhibits the secretion of triacylglycerol and of apoprotein B and the binding of LDL in Hep G2 cells

The consumption of long chain polyunsaturated fatty acids by fish oils leads to profound lowering of plasma triacylglycerol but not of plasma cholesterol. Reasons for this were investigated with the human hepatoma cell line, the Hep G2 cell. Incubations with oleic acid (18:1 n9), linoleic acid (18:2 n6) and the characteristic marine fatty acid eicosapentaenoic acid (EPA, 20:5 n3) enriched cellular triacylglycerol mass, though least with EPA. However, secretion of very low density lipoprotein (VLDL) triacylglycerol and apoprotein B (measured by formation from [3H]glycerol and [3H]leucine) was markedly inhibited by EPA. Preincubation with linoleic acid reduced VLDL triacylglycerol but not apo B secretion in comparison with oleic acid which stimulated both. A possible effect on low density lipoprotein (LDL) removal was studied by measuring [125I]LDL binding. Preincubation with either EPA or linoleic acid inhibited the saturable binding of LDL, observed with oleic acid and control incubations. The binding of lipoproteins containing chylomicron remnants was not affected by any of the fatty acids.

Why are (or are not) patients given the option to enter clinical trials?

Much attention has been paid to the use of ethical principles to guide the conduct of clinical trials. Less has been done to clarify and assess the "weights" assigned by clinicians (and others) to the values that come into conflict when patients are offered entry into trials. Quantitative techniques of value assessment were used to measure the relative importance of variables frequently identified as barriers to the entry of patients into clinical trials. Responses were obtained from 52 oncologists, 26 clinical trials and senior nurses, and 23 family physicians. The group of oncologists identified the scientific design of the trial as the most important factor. In contrast, the groups of nurses and family physicians gave higher weight to effects of the trial on the doctor-patient relationship. The results illustrate ways in which methods of value assessment may be used to clarify and rank values.

Effect of posture on vital capacity

The influence of some extreme body postures on vital capacity (VC) was examined in young adult humans. Two postures required full support of body weight by the arms: arms up, hanging from a bar, and arms down with hands gripping parallel bars. Three involved muscles that flex and extend the trunk: a partial sit-up position while supine and nearly maximal spinal extension and flexion while standing. Changes at the inspiratory and expiratory volume extremes were recognized by having the subjects do two VC efforts: the first standing and the second in the posture in question while continuing to breathe on the spirometer. Control observations in which the second of a VC pair was performed in an unstressed posture allowed correction for the influence of rebreathing. The changes in corrected VC were small, the greatest being an average reduction of approximately 8% in the partial sit-up position. During full support of body weight by the arms, the VC was slightly increased due to a significant increase in the inspiratory extreme and no change in the expiratory extreme. Spinal extension produced small increases in lung volume at both extremes with no significant change in VC, whereas spinal flexion did not influence the upper extreme but did increase lung volume at the lower extreme. The changes are discussed in terms of trunk muscle action.

A spectrin-like protein in retinal rod outer segments

Biochemical and immunochemical studies indicate that rod outer segments (ROS) of bovine photoreceptor cells contain a Mr 240,000 polypeptide related to the alpha-subunit of red blood cell (RBC) spectrin. With the use of sodium dodecyl sulfate gel electrophoresis in conjunction with the immunoblotting technique, monoclonal antibody 4B2 was found to bind to a Mr 240,000 polypeptide in ROS that is distinct from the prominent Mr 220,000 concanavalin A binding glycoprotein. The Mr 240,000 polypeptide is highly susceptible to degradation by endogenous proteases. It does not appear to be an integral membrane protein but is tightly membrane associated since it can be partially extracted from ROS membranes with urea in the absence of detergent. The 4B2 antibody cross-reacted with RBC ghosts and bovine brain microsomal membranes. Radioimmune assays and immunoblotting analysis of purified bovine RBC spectrin further revealed that the 4B2 antibody predominantly labeled the alpha-chain of RBC spectrin having an apparent molecular weight of 240,000. Polyclonal anti-spectrin antibody that bound to both the alpha- and beta-chain of RBC spectrin predominantly labeled a Mr 240,000 polypeptide of ROS membranes. Two faintly labeled bands in the molecular weight range of 210,000-220,000 were also observed. These components may represent variants of the beta-chain of spectrin that are weakly cross-reacting or present in smaller quantities than the alpha-chain.(ABSTRACT TRUNCATED AT 250 WORDS)