Portal-systemic myelopathy after transjugular intrahepatic portosystemic shunt creation: report of four cases

The authors attempted to describe the clinical manifestations of portal-systemic myelopathy (PSM) after transjugular intrahepatic portosystemic shunt (TIPS) creation. PSM was developed in four of 212 (1.89%) patients who underwent TIPS procedures in our hospital. Three men and one woman, ranging in age from 41 to 56 years, with a history of posthepatitis cirrhosis and recurrent bleeding from gastroesophageal varices had intrahepatic shunts created with 10-mm-diameter Wallstents. Shunt patency was confirmed by color Doppler ultrasonography (US) in each patient after TIPS creation. Progressive spastic paraparesis involving the lower extremities occurred between 5 weeks and 5 months after TIPS creation in the four patients. Neurologic examination showed evidence of spasticity in all cases, with ankle clonus, extensor plantar responses, and lower extremity hyperreflexia. All sensory modalities remained intact. Cytologic examination of cerebrospinal fluid from each patient was normal. There was no evidence of spinal cord compression on the imaging studies. PSM is a rare syndrome that includes spastic paraparesis with intact sensation. Initially noted in patients who have undergone surgical placement of a portacaval shunt, it also may occur after TIPS creation.

Isolated lower extremity chemotherapeutic infusion for treatment of osteosarcoma: experimental study and preliminary clinical report

PURPOSE

To increase the dose of drug delivered to a tumor while maintaining tolerable systemic side effects, an interventional technique of isolated lower extremity infusion was investigated.

MATERIALS AND METHODS

Experiments were performed in eight dogs. Four dogs were treated by a combination of intraarterial (IA) femoral cisplatin infusion at a dose of 2.0 mg/kg with drug removal from the ipsilateral extremity venous blood by a dialyzer. The other four dogs comprised the control group. In these animals, left femoral arterial IA cisplatin infusion was performed without dialysis. Leukocyte and platelet counts, blood urea nitrogen (BUN) levels, and serum creatinine levels were recorded before and after the treatment. Subsequently, two human patients with inoperable osteosarcoma were treated with the isolated infusion.

RESULTS

In the experiments, 85%-90% of the free platinum that entered the dialyzer was removed. The peak systemic plasma cisplatin concentrations in animals undergoing dialysis were reduced by 81.25% compared to those in animals undergoing femoral IA infusion without hemodialysis. There were no significant changes in the hematologic profiles or BUN and serum creatinine levels in the experimental animals. However, in the control group, all dogs developed myelosuppression and severe renal toxicity after IA infusion of the same dose of cisplatin. Clinically, immediate relief of symptoms related to the primary tumor was achieved in both human patients after the combination of isolated IA infusion and embolotherapy.

CONCLUSION

Single-pass hemodialysis removed a significant amount of cisplatin after regional IA infusion, reduced systemic toxicity, and permitted survival of the experimental animals. In two patients with osteosarcoma, percutaneous isolated lower extremity chemotherapeutic infusion therapy and embolotherapy were performed safely with partial responses.

Is the superior belly of the lateral pterygoid primarily a stabilizer? An EMG study

The aim of the present study was to compare the activity levels within the two bellies of the lateral pterygoid muscle between different jaw positions to test the hypothesis that the upper head is primarily a stabilizer. Electromyographic (EMG) recordings, using monopolar concentric needle electrodes, were made from 14 healthy subjects during mandibular rest position (RP), clenching in intercuspal position and jaw opening, first about 10 mm and then about 25 mm. Both bellies had very little activity during RP. The activity level of the superior belly was high during clenching and large opening (LO) with a dip during low opening degree. This pattern differed from that of the inferior belly where the activity was relatively low during clenching and then gradually increased to its highest level during LO. The results support that the lower belly is primarily a jaw opener while the superior belly acts as a stabilizer keeping the disc and condyle in a functionally stable position during clenching and jaw movements.

Delayed complications after esophageal stent placement for treatment of malignant esophageal obstructions and esophagorespiratory fistulas

PURPOSE

To evaluate delayed complications after esophageal expandable metallic stent placement.

MATERIALS AND METHODS

From April 1993 to December 1997, 90 expandable metallic stents were placed in 82 consecutive patients with inoperable malignant esophageal obstruction (n = 49) or malignant esophagorespiratory fistula (n = 33). Stents used included covered Gianturco-Rosch Z stents (n = 20), Wallstents (covered, n = 31; uncovered, n = 13), and Ultraflex stents (covered, n = 8; uncovered, n = 10). Patients were followed prospectively and monitored for delayed complications, defined as major (hemorrhage, tracheal compression, stent migration, perforation or fistula formation, granulomatous obstruction, tumor ingrowth and overgrowth, funnel phenomenon, and stent covering disruption) or minor (reflux, chest pain, and food impaction).

RESULTS

Mean survival was 4.5 months after stent placement (range, 3 weeks to 26 months). The overall incidence of delayed complications was 64.6%, with 17 patients (20.7%) experiencing more than one complication. The rates of delayed complications in patients with Z stents, Wallstents, and Ultraflex stents were 75.0%, 68.1%, and 44.4%, respectively (P <.05). Most complications were life-threatening and occurred more frequently when stents were placed in the proximal third of the esophagus, compared with more distally (P <.05). Thirteen patients (15.9%) died from complications directly related to stent placement.

CONCLUSION

Esophageal stent placement for malignant obstruction or fistula is associated with a substantial incidence of delayed complications.

[Affect of heredity, disease and environment on the life-span of personage in History Book of Song Dynasty]

The data have been sorted and calculated by statistics for personages' life-span according to surname and Yin-Yang type and disease according to the cause of pattern over 793 personage from the biography of emperor families' and official in feudal times and subjects of the feudal ruler in History Book of Song Dynasty. (1) For there are some genetic diseases causing their earlier death in surname Zhao's, the average value of life-span is shorter than the other surname of Wang, Li, Zhang, Liu and Chen's. Because the average value among those five surnames are not different each other, the character of the distribution of every one's tally with neuter alleles. (2) The average value in a population on a type of mild Yin and Yang is higher than the type of Yang only, P < 0.05. (3) Disease and bad environment are the limiting factors for life. Besides, to rise the resistance ability is an important path way for increasing our life-span. The attribute of a genetic system in Yin or Yang is an objective existence. Influence on life by genetics may vary with various disease and environment, but different disease is controlled genetically. A bad environment may affect life, but neuter environment would be affected the life through attribute of a genetic system in Yin or Yang type indirectly.

Selected lifestyle and risk behaviors associated with adolescents' smoking

A selected number of lifestyle and risk behaviors of adolescents in relation to their smoking were studied using both longitudinal and cross-sectional analyses. Data of a national sample of 4,431 nonsmoking adolescents who participated in the 1989 Teenage Attitudes and Practices Survey and were re-interviewed in 1993 were analyzed. Adolescents who engaged in physical fights, engaged in drunk driving, and were risk-takers were more likely to be regular experimental smokers than adolescents who did not exhibit these behaviors. The data suggest that high-risk behaviors may cluster. Interventions may be necessary to target multiple risk behaviors and be more effective in changing adolescents' risk behaviors associated with smoking.

Smoking acquisition: peer influence and self-selection

The study examined and contrasted the extent that peer influence and self-selection for smoking peers may affect acquisition of smoking by adolescents. Data for a U.S. national cohort sample of adolescents (N = 4,444) who were nonsmokers in the 1989 Teenage Attitudes and Practices Surveys and were re-interviewed in 1993 were included. The information included measures of smoking behavior and smoking status of both boys' and girls' best friends. Analysis demonstrated that, although the effects of both peer influence and self-selection of smoking friends occurred, self-selection may play a greater role in adolescents' beginning to smoke. This implies that, while teaching adolescents to resist peer pressure may be necessary, it is perhaps more important to identify factors that influence adolescents' decisions in choosing friends who smoke. This could lead to more effective preventive strategies.

Drug use and HIV risk--related sex behaviors: a street outreach study of black adults

BACKGROUND

Our street outreach project investigated the relationship between use of noninjecting drugs (alcohol, marijuana, cocaine) and human immunodeficiency virus (HIV) risk-related sex behaviors of black adults. The study focused on three HIV-related risks: multiple sex partners, unprotected sex, and drugs during sex.

METHODS

Data for this study were collected in a street outreach community survey for a drug abuse and HIV intervention study in Birmingham, Ala. A total of 780 black men and women completed the survey.

RESULTS

High-risk sex behaviors were far more prevalent among cocaine users than marijuana or alcohol users. A greater number of cocaine users reported having multiple sex partners, not using condoms, and using drugs during sex. Female cocaine users showed the same risk level for HIV infection as male cocaine users.

CONCLUSIONS

Increased risk of HIV infection through sexual transmission is associated with use of noninjecting cocaine for both men and women. Condom use should be considered as a major component of HIV prevention programs.

Evaluation of the exposure effects of a theory-based street outreach HIV intervention on African-American drug users

The Street Outreach to Drug Abusers-Community AIDS Prevention (SODA-CAP) Project implemented and evaluated an HIV-prevention intervention aimed at current drug users. The intervention was developed using social cognitive theory and the transtheoretical model of change. The outreach team assessed individuals' stages of change for the target behaviors and they were given stage-appropriate role-model stories. The program effects were evaluated using a quasi-experimental design with a repeated, cross-sectional sampling method in which community surveys were administered at baseline, 12 and 22 months. Multivariate statistical models were developed for four outcomes (condom use with main and other partners, treatment entry, and stopping all drug and alcohol use). Exposure to intervention was a significant predictor for condom use with other partners and for stopping drug and alcohol use.

AIDS knowledge among black drug users: an issue of reliability

This study examined the reliability of an inventory measuring AIDS-related knowledge among 553 black drug users. Data were collected from a socially high-risk community in Birmingham, Alabama. The KR-20 reliability scores were computed from the inventory for each drug-use group. The KR-20 reliabilities ranged from .39 to .57. These findings may suggest that the inconsistent reports of the predictive power of AIDS knowledge among drug users reported in previous studies might be related to the low internal consistencies of the inventory.

Prospective social-psychological factors of adolescent smoking progression

PURPOSE

To evaluate the ability of social-psychological risk factors to predict adolescent smoking behavior.

METHODS

Nonsmoking adolescents (n = 4032) who participated in the 1989 and 1993 Teenage Attitudes and Practices Surveys (TAPS I) were selected for analyses. Four multivariate logistic models were used to examine (a) adolescents' smoking initiation, (b) adults' smoking initiation, (c) adolescents' progression to regular smoking, and (d) adults' progression to regular smoking. A series of social-psychological variables were measured.

RESULTS

All four models were significant. However, no social-psychological factors were consistently significant in all four models, except white ethnicity. Data showed that social-psychological factors are less able to predict the transition from nonsmoking to experimental smoking than that from nonsmoking to regular smoking.

CONCLUSIONS

Future prospective studies should measure both social-psychological and smoking acquisition factors at closer intervals to more accurately examine potential relationships.

Lactate production in response to maximal and submaximal StairMaster PT4000 and treadmill exercise

BACKGROUND

The purpose of this study was to measure the amount of lactate produced, as an indication of fatigue, in response to maximal and submaximal stairstepper (SM) and treadmill (TM) exercise.

METHODS

Thirty volunteers (15 males, mean age 23 yrs; 15 females, mean age 22 yrs) completed maximal and submaximal SM and TM protocols on four separate visits to the laboratory to determine maximal oxygen consumption (VO2max), and blood lactate concentrations. Maximal TM testing consisted of the Bruce protocol, while the maximal SM protocol involved progressing in increments of 2 levels every 2 minutes. Eight minutes of submaximal TM and SM exercise was performed at an intensity of 65% of VO2max, as measured during maximal TM and SM testing. Fifty microliters of blood was collected via fingerprick of the index finger prior to, and immediately post maximal and submaximal TM and SM exercise, and during minutes 3, 5, and 7 of active recovery. Red blood cells were lysed and analyzed immediately using the YSI # 1500 Sport lactate analyzer.

RESULTS

TM-VO2max, was significantly higher for both, males and females, compared to SM-VO2max. Repeated measured analyses of variance revealed significantly higher blood lactate levels during the same relative submaximal workloads for SM compared to TM exercise.

CONCLUSIONS

These findings suggest that an increased lactate production during submaximal SM exercise may result in early fatigue and, thereby, limit maximal performance on the SM.

Osteoporotic fracture among older U.S. women: risk factors quantified

The purpose of this study was to develop a predictive model for osteoporotic fracture among a national sample of 2,325 women ages 50 years and older. Predictors for examination included age, race, heredity, body mass index (BMI), physical activity, smoking status, alcohol use, and dairy product use. Analyses were conducted using Standard Analysis System (SAS) procedures. Strong risk factors predicting osteoporotic fracture included age, race, low BMI, and inactivity. Recommendations emphasize screening of high-risk women, achieving and maintaining health body weights for underweight women, and obtaining moderate physical activity. Promotion of healthy body weights for women of all ages is emphasized. Recommendations also include encouraging widespread physician, patient, and public education regarding osteoporotic fracture.

Risk factors for hip fracture among southern older women

BACKGROUND

Older women are considered at risk for hip fracture; fracture rates are highest in the southern region of the United States. The purpose of this study was to develop a predictive model for osteoporotic hip fracture among a national sample of southern women aged 50 years and older.

METHODS

Subjects were participants in the Third National Health and Nutritional Examination Survey, Phase 1. Data were collected by the National Center for Health Statistics. Predictors examined included age, race, heredity, body mass index, physical activity, smoking status, alcohol use, and dairy product use.

RESULTS

The sample consisted of 953 women aged 50 years and older. The predictive model included older age, black race, Hispanic race, and low body mass index.

CONCLUSIONS

Recommendations emphasize weight gain for underweight women and promotion of healthy body weights for women of all ages.

School dropouts' attitudes and beliefs about smoking

The purpose of this study was to examine the association of beliefs and attitude related to smoking and smoking behavior among school dropouts in a national sample (weighted N = 492,352). The self-reported smoking rate for school dropouts was 58.3%. Those who were most positive about smoking (such as smoking helps people reduce stress and relax, reduce boredom) were more likely to be smokers (p < .05). Smoking programs targeting this population should provide coping skills and an environment with options for relaxing, managing stress, and safe weight control.

Depressive symptoms as correlates of polydrug use for blacks in a high-risk community

BACKGROUND

This study examined the relationship between depressive symptoms and polydrug use (alcohol, marijuana, and cocaine) among blacks in a high-risk community.

METHODS

A street sample (N = 570) from four high-risk communities in Birmingham, Alabama, was collected through personal interviews. Interviewers asked respondents about their drug use behavior during the past 30 days, as well as about their depressive symptoms during the past week.

RESULTS

Odds ratios and logistic regressions, adjusted for age and sex, were used to assess the relationship between depressive symptoms and drug and polydrug use (drug use involving cocaine). Results showed that depressive symptoms are significantly associated with polydrug use. However, depressive symptoms were not associated with alcohol use or with the combination of alcohol and marijuana use.

CONCLUSIONS

Depressive symptoms are related to polydrug use involving cocaine, though the causal relationship is uncertain. Previous reports on depressive symptoms and alcohol or marijuana may be inconclusive.

Immunomodulating activity of Chinese medicinal herbs and Oldenlandia diffusa in particular

The effect of eight different Chinese medicinal herbs (CMHs) on lymphocytes was studied in vitro using murine spleen cells. Among the studied eight CMHs, Astragalus membranaceus and Oldenlandia diffusa markedly stimulated murine spleen cells to proliferate. The responder cells for CMHs were B cells, because the response was depleted by the treatment of spleen cells with anti-immunoglobulin (i.g.) antibody and complement and after purification by nylon wool column. This response was not due to contamination by lipopolysaccharide (LPS), because CMHs could stimulate C3H/HeJ spleen cells which are low responders to LPS. CMHs enhanced the production of Ig. CMHs also enhanced the induction of allo-antigen specific cytotoxic T lymphocytes. However, CMHs had no effect on natural killer cells. Furthermore, CMHs stimulated macrophages to produce interleukin-6 and tumor necrosis factor. The electroelution of the proteins from SDS-PAGE gel showed that the active components of Oldenlandia diffusa had an apparent molecular weight of 90-200 kD and were sensitive to pronase E and NaIO4 treatment, suggesting glycoproteins in nature. These results suggest that CMHs have immunomodulating activity in vitro and this activity could be used clinically for the modulation of immune responses.

The anti-angiogenic agent fumagillin covalently binds and inhibits the methionine aminopeptidase, MetAP-2

The inhibition of new blood vessel formation (angiogenesis) is an effective means of limiting both the size and metastasis of solid tumors. The leading anti-angiogenic compound, TNP-470, has proven to be effective in in vitro and in animal model studies, and is currently being tested in phase III antitumor clinical trials. Despite many detailed pharmacological studies, little is known of the molecular mode of action of TNP-470. Using a derivative of the TNP-470 parent compound, the fungal metabolite, fumagillin, we have purified a mammalian protein that is selectively and covalently bound by this natural product. This fumagillin binding protein was found to be a metalloprotease, methionine aminopeptidase (MetAP-2), that is highly conserved between human and Saccharomyces cerevisiae. In the absence of MetAP-1, a distantly related methionine aminopeptidase, MetAP-2 function is essential for vegetative growth in yeast. We demonstrate that fumagillin selectively inhibits the S. cerevisiae MetAP-2 protein in vivo. The binding is highly specific as judged by the failure of fumagillin to inhibit MetAP-1 in vivo. Hence, these results identify MetAP-2 as an important target of study in the analysis of the potent biological activities of fumagillin.

B cell stimulating activity of seaweed extracts

The activity of seaweed extracts on murine and human lymphocytes was studied in vitro. The extracts of some kind of seaweed, such as Hizikia fusiformis and Meristotheca papulosa, stimulated normal mouse spleen cells to proliferate. The responder cells are B cells, because the response was depleted by the treatment of spleen cells with anti-immunoglobulin (Ig) antibody and complement and being passed through a nylon wool column. This response is not due to lipopolysaccharide (LPS) contamination, because seaweed extracts can stimulate spleen cells of C3H/HeJ mice which are LPS low responders. Seaweed extracts also enhanced Ig production by B cells and tumor necrosis factor (TNF) production by macrophages. Furthermore, seaweed extracts stimulated human lymphocytes to proliferate. All these B cell stimulating activities of seaweed extracts associated with glycoproteins whose molecular weights resided in 100 kD. These results suggest that seaweed extracts have stimulating activity on B cells and macrophages and this ability could be clinically for the modulation of immune responses.

The impact of worksite-based safety belt programs: a review of the literature

PURPOSE

The purpose of this paper is to provide a literature review of the research that examines the effectiveness of worksite intervention programs designed to increase the use of safety belts by employees.

SEARCH METHODS

The literature search, which identified 14 research studies on worksite safety belt programs conducted between 1968 and 1994, originated as part of a larger review on the health impact of worksite health promotion programs that was conducted by the Centers for Disease Control and Prevention (CDC). In addition, the authors conducted an additional search in an effort to validate the CDC search, but found no additional research articles.

SUMMARY OF IMPORTANT FINDINGS

The literature specific to the effectiveness of safety belt programs is limited to only 14 studies. The safety belt intervention most commonly evaluated used behavioral modification principles involving incentives. These and other interventions demonstrated effective increases in seat belt utilization that, upon withdrawal of the intervention, achieved a recidivism rate above baseline levels. However, the vast majority of studies failed to incorporate control groups into their research design, which caused significant threats to internal validity. Thus, a summary of findings is only suggestive at best.

MAJOR CONCLUSIONS

Based on the literature, there appears to be an insufficient number of quality research studies from which to derive a clear view of the impact of worksite safety belt programs. While the evidence is suggestive of a positive impact on safety belt use, there is a clear need for new, well-designed research initiatives on the effectiveness of theory-based safety belt intervention programs.

Social influence on southern adolescents' smoking transition: a retrospective study

The purpose of this study was to examine social factors that predicted adolescent smoking transition to more advanced stages of smoking behavior during a 3-year span. A national cohort sample of adolescents (N = 2,099) who participated in the 1989 and 1993 Teenage Attitudes and Practices Survey (TAPS I and TAPS II, respectively) was used for this study. The information obtained from this survey included measurements of smoking behavior and a series of factors related to smoking models in the respondents' social environment, such as smoking behavior of parents, siblings, and best friends. Results showed that the smoking behavior of an adolescent's best male friend was consistently associated with transition from nonsmoking to regular smoking and from experimental smoking to regular smoking. The most surprising finding was that the study showed no relationship between social influence and transition from nonsmoking to experimental smoking.

Sociobehavioral influences on smoking initiation of Hispanic adolescents

PURPOSE

To study the sociobehavioral influences on smoking initiation of Hispanic adolescents over a 3-year period using a national sample.

METHODS

Hispanic adolescents (N = 385), ages 15-22 years, from the 1989 and 1993 Teenage Attitudes and Practices Surveys (TAPS I and II), were selected for analyses. Data collected included measures of smoking initiation and attitudes, beliefs toward smoking of the adolescent, and smoking status of family and peers.

RESULTS

At the 3-year follow up, 43.4% of nonsmokers at TAPS I had initiated smoking. Risk factors associated with initiating smoking were having male and/or female friends who smoked, and positive attitudes and beliefs towards smoking. Parental and sibling smoking status had little effect on adolescent smoking status.

CONCLUSIONS

The peer influence on Hispanic adolescent smoking is consistent with previous research on Caucasian and African-American adolescents. The formation of attitudes and beliefs toward smoking in this population warrants further examination given the influence of attitudes and beliefs on smoking initiation in this study.

Dysfunction of immune system and induction of autoantibodies to liver antigens by neonatal thymectomy in mice

We examined the development of autoantibodies to liver proteins and hepatitis in BALB/c mice thymectomized 2 days after birth and attempted to characterized the immune function of these mice. Autoantibodies to crude liver proteins detected by ELISA were found in 21 (84%) of 25 mice thymectomized 2 days after birth. In these mice, sera of 11 animals showed reactivity with both liver specific proteins (LSP) and the second fraction of crude liver proteins; sera of 3 mice showed reactivity with only the second fraction but sera showed reactivity with only LSP. By Western-immunoblotting, sera of BALB/c mice which showed high autoantibody level to liver proteins detected a strong band around 150kD in the second fraction of crude liver proteins. Still more, hepatic inflammation; mononuclear cell infiltration in the portal area, was induced in mice with apparently high autoantibody level to crude liver proteins. These results in BALB/c mice corresponded with our previous reports which employed C3H/HeN mice. Next, we examined immune functions of mice thymectomized 2 days after birth. In thymectomized mice, the proportion of Thy-1, L3T4 and Lyt-2 positive cells (T cells) decreased and the proportion of B220 positive cells (B cells) increased. The proliferative response of lymph nodes lymphocytes cultured with mitomycin C-treated syngeneic spleen cells was lower, and the total IgG level in the sera was higher when compared with control normal mice. Anti-nuclear antibody (ANA) also appeared in the sera of thymectomized mice 2 days after birth. All these results suggest that the dysfunction of T cell and polyclonal activation of B cell were induced in neonatally thymectomized mice and resulted in the production of ANA and autoantibodies to liver proteins.

Association of depressive symptoms and school adolescents' smoking: a cross-lagged analysis

This study examined the association of depressive symptoms of adolescents and their smoking behavior. A national cohort sample of school adolescents (N = 5,855) who participated in the 1989 and 1993 Teenage Attitudes and Practices Survey was obtained. The information from this survey included measures of smoking behavior and a series of factors related to depressive symptoms during a 3-yr. span. A cross-lagged analysis with Kendall tau b correlations was used. Judging from the magnitude of the cross-lagged correlations, the direction of causation cannot be ascertained. Rather, a reciprocal relationship between depression and smoking may be suggested.

The compensatory model in weight control: relapse prevention revisited

Acknowledging Baker's 1996 critique of our recent work in this Journal, comments are provided.

Diagnosis of an accessory portal vein and its clinical implications for portosystemic shunts

PURPOSE

To present a peculiar anatomic portal veins variant and evaluate its clinical implications.

METHODS

Among 118 consecutive patients undergoing transjugular intrahepatic portosystemic shunting (TIPS), six male patients were found to have an accessory portal vein, which was seen during direct portography.R ESULTS: In all six patients, portograms showed an accessory small-caliber vein parallel to the trunk of the main portal vein ending in the right lobe of the liver. Two of the six accessory portal veins drained blood from coronary veins, precluding access to coronary vein embolization during TIPS.

CONCLUSION

An accessory portal vein is a rare anatomical variation with clinical significance for both surgical shunt placement and TIPS, as well as for transportal embolization of coronary veins.

The association between parental smoking and the diet quality of low-income children

OBJECTIVE

To assess the association between parental smoking and the diet quality of children residing in low-income housholds in the United States. MTHODS: Data from 515 low-income children (less than or equal to 185% of the poverty line), ages 2 to 17, who participated in the 1989 and 1990 United States Department of Agriculture Continuing Survey of Food Intakes of Individuals were examined. Diet quality was assessed by examining the average daily amount of nutrients consumed per 1000 kcal for protein, fiber, and 14 essential vitamins and minerals as well as total energy, percent of energy from total fat and saturated fat, and cholesterol and sodium intakes using the 3-day average of one 24-hour recall and 2 days of diet records. Parental smoking was categorized as four levels (nonsmoker; 1 to 10, 11 to 20, and more than 20) on the basis of the average number of cigarettes smoked per day by the sample child's parents. Analysis of covariance examined differences in the children's nutrient intake among the four smoking categories while controling for race, mother's age and occupation, child age, and sex.

RESULTS

Low-income children with parents who smoked (n = 235) were more likely to be white (P <.001), had younger mothers (P <.05) and were more likely to have mothers employed in blue-collar occupations (P <.001) than children whose parents were nonsmokers (N = 280). Children whose parents smoked more than 20 cigarettes per day had a higher level of energy from saturated fat, and children whose parents smoked 11 to 20 cigarettes per day had the highest cholesterol intakes in comparison with the rest of the sample. Parental smoking was also related to total fiber intake per 1000 kcal, with children of smokers having lower fiber intakes than children of nonsmokers.

CONCLUSIONS

On average, low-income children of smokers had a poorer diet quality than low-income children of nonsmokers, thus increasing their future risk of chronic disease.

B cell mitogenic activity of Toxocara canis adult worm antigen

The effect of Toxocara (T.) canis antigen (TcAg) on lymphocytes was studied in vitro using normal murine spleen cells and human peripheral blood lymphocytes. TcAg prepared from adult worms stimulated murine spleen cells to proliferate at concentrations of 1-125 micrograms/ml. The responder cells TcAg are B cells, because the response was depleted by the treatment of spleen cells with anti-immunoglobulin (Ig) antibody and complement and after separation on a nylon wool column. This response was not due to the contamination of lipopolysaccharide (LPS), because TcAg could stimulate C3H/HeJ spleen cells which are low responders to LPS. Not only the proliferative response but also polyclonal IgG and IgE production were stimulated with TcAg. TcAg also stimulated macrophages to produce interleukin-1 and could stimulate human B cells. These results suggest that TcAg is a potent B cell mitogen and this activity may be relevant to the alteration of immunological functions in hosts infected with T. canis.

Transjugular intrahepatic portosystemic shunts: midterm results in 28 patients

This paper reports the clinical and procedural results of 28 consecutive TIPS procedures in 25 males and three females with a mean age of 48 years. All patients had cirrhosis with portal hypertension and varices. Twenty-two patients had recurrent bleeding. Shunts were completed in 26 of 28 patients, and no death was associated with the procedure. Portal vein pressure was reduced from 3.98 +/- 0.24 KPa before shunting to 2.40 +/- 0.16 KPa after shunting. Doppler US revealed that the maximum blood flow velocity in the main portal vein increased from 14.0 +/- 4.5 cm/sec to 48.0 +/- 16.5 cm/sec. Shunt patency was determined by color Doppler US in 20 patients. Shunt stenosis was found in five patients and occlusion in one, and these findings were confirmed by angiography. Ascites disappeared in six of eight cases, and varices disappeared completely in 11 patients and abated greatly in 12 patients two months after TIPS. Rebleeding occurred in three cases (occlusion, 1; stenosis, 2) during a mean follow-up time of 6.5 months. One of these cases was successfully redilated. The initial results suggest that TIPS is a safe and effective method of portal decompression and that the key to portal vein puncture is to understand the three-dimensional relationship between the hepatic and portal veins.

Preventing relapse in weight control: a discussion of cognitive and behavioral strategies

Weight maintenance is the most difficult part of weight control. People who diet and regain weight often experience negative physiological effects and lowered self-esteem each time they regain weight. This suggests the need for successful weight maintenance programs. Health-care professionals can develop and implement maintenance programs using cognitive and behavior-change strategies which include ways to cope with relapse. This paper describes the physiological and emotional problems associated with weight maintenance and explores the use of cognitive and behavioral concepts in addressing these issues.

Physiological sensations of initial smoking in the development of regular smoking behavior

This study examined the relationships between adolescents' physiological sensations of smoking during initiation and early experience. For a national sample of a birth cohort of 2,043 adolescents, ages 15 to 22 years at the follow-up, variables of interest included measures of smoking behavior and physiological sensations reported from the initial smoking experience. Analysis showed that adolescents experimenting with smoking were more likely to become regular smokers over three years if they indicated that they felt relaxed, felt dizzy, did not feel sick, and did not cough during the initial smoking experience. Antismoking interventions may impede the transition to regular smoking by helping adolescents interpret the physiological sensations as negative and unhealthy.

Developmental influences of attitudes and beliefs on adolescents' smoking

This study examined developmental influences of beliefs and attitudes on adolescents' smoking. A national sample (N = 6,900) of adolescents ages 14 to 18 was selected. Data included measures of smoking behavior, beliefs, and attitudes. Although odds ratios show that attitudes and beliefs are predictive of adolescents' smoking status across the ages of 14 to 18 years, no systematic change of the prediction is evident, which contrasts with the psychological developmental model.

Family and peer influences on smoking behavior among American adolescents: an age trend

PURPOSE

To study the age trend of family and peer influence on adolescent smoking behavior using a national sample.

METHODS

Adolescents (N = 6,900), ages 14 through 18 years, from the 1988-89 Teenage Attitudes and Practices Survey, were selected for analyses. Data collected included measures for smoking status of the adolescent and their family and peers.

RESULTS

Peer influence, such as the smoking status of best male/female friends, proved to be the most significant and consistent predictor across all ages, while parental influence had little effect on adolescent smoking status. Gender-specific effects were noted in the peer influence of adolescent smoking.

CONCLUSIONS

The peer influence on adolescent smoking, across ages 14 through 18 years, confirmed previous literature. However, no differential effect of family and peer influence on adolescent smoking was evident.

Associations between academic performance of division 1 college athletes and their perceptions of the effects of anabolic steroids

Data on the relationship between academic performance (grade point average) of college athletes and their perceptions of the effects of anabolic steroids on their sport and their performance were collected from Division 1 athletes (N = 1,638) representing 12 varsity sports chosen from five universities nationwide. The response rate was 74%. Analysis yielded differences between athletes with high and low GPAs in perceptions of the effects of anabolic steroids. The lower the GPA, the less likely the athletes were to believe that anabolic steroids are a threat to health, are a problem in their sport, and are addictive. Also, they were more likely to believe that anabolic steroids enhance performance.

The acute effect of moderate alcohol consumption on cardiovascular responses in women

OBJECTIVE

The purpose of this study was to assess the effects of moderate dose alcohol consumption on human metabolic and cardiovascular responses during submaximal exercise.

METHOD

Ten female subjects participated in two experimental conditions: (1) an alcohol session where the subjects ingested 0.625 g per kg body weight of 80-proof ethyl alcohol (0.25 g/kg of 100% ethanol), and (2) a placebo session. In each session, the subjects exercised on a stationary bicycle at 70% predicted maximum heart rate (HR) for 30 minutes. HR, blood pressure (BP) and oxygen consumption (VO2) were measured at the baseline and at 10, 20 and 30 minute intervals during exercise. Blood lactic acid (BLA) was measured at the baseline and at the end of exercise.

RESULTS

Repeated analysis of variance and subsequent comparisons showed that the alcohol session had significantly higher scores for HR, BP, VO2 and BLA than the placebo session (p < .05).

CONCLUSIONS

These results suggest that during submaximal work, acute moderate alcohol consumption may interfere with aerobic energy metabolism, thus increasing the demand placed upon the cardiovascular system.

The value of ten common exercise tolerance test measures in predicting coronary disease in symptomatic females

The diagnostic contribution of ten common exercise tolerance test (ETT) measures compared with coronary angiography was studied in 62 symptomatic females (mean age = 53 +/- 9 years). Logistic regression revealed that maximal ST-segment depression, the percent of predicted maximal heart rate achieved, and test chest pain all contributed unique predictive information and formed a model generating probabilities for coronary disease (CAD). Using a predicted probability for the presence of CAD of 0.50 as a cutpoint, test accuracy was markedly improved (sensitivity = 73%, specificity = 94%, and overall correct classification rate = 90%) over the standard ST response. We conclude that multivariate analysis using these three easily assessed ETT measures provides superior discrimination between symptomatic women with and without CAD when compared to changes in the ST-segment alone.

Relationship of alcohol consumption and recreational boating in Beaufort County, North Carolina

The purpose of this study was to examine the relationship between alcohol use and recreational boating activities. Two hundred eleven (n = 211) boaters were surveyed at three boating access locations in Beaufort County, North Carolina. The survey questionnaire consisted of fifteen questions designed to obtain information on boat operators and their use of alcoholic beverages while engaging in boating activities. Prevalence and amount of alcohol use while boating were significantly associated (p < .05) with the type of activity engaged in. Among those boaters who had received some type of boating safety education, a higher prevalence of alcohol use while boating was observed. The prevalence and amount of alcohol use while boating were found to be significantly (p < .05) associated with the location (public versus private) of boating access. In light of the findings, it is apparent that boating alcohol education and legislation for the North Carolina boating population need assessment and revision. The implications of the findings could have far-reaching effects upon education and prevention among the recreational boating population, particularly if further research in this area supports these finding.

Southern adolescents: a survey of attitudes and beliefs about smoking

Using data collected by the National Center for Health Statistics, we examined the relationships between smoking-related beliefs and attitudes and smoking status for a sample of adolescents (N = 3,198) from southern states. Stepwise logistic regression was used to identify the best predictors of smoking prevalence. Results indicated that 8 of 13 variables in the logistic model significantly differentiated between smokers and nonsmokers. Smokers were more likely to believe that it is safe to smoke for only a year or 2 and that smoking helps reduce stress and boredom while promoting relaxation. Smokers also reported a higher tolerance than nonsmokers for being around other smokers, and reported their parents would not mind their smoking. The logistic model attained a predictive accuracy of 93.2%. The implication of these findings is that if smoking interventions targeted at adolescents address smoking-related beliefs and attitudes, there is an enhanced likelihood that such interventions will positively influence the smoking behavior of southern adolescents.

[Immunohistochemical study on estrogen receptors in conventionally formalin-fixed, paraffin-embedded tissues of endometrial carcinoma]

Using specific monoclonal antibody to human estrogen receptors (ER), monoclonal antibody H222, with an avidin-biotin-peroxidase complex method, immunohistochemical localization of ER was performed on formalin-fixed, paraffin-embedded tissues of 42 endometrial carcinomas. The paraffin sections were preceded by trypsin treatment to expose antigenic sites. Immunohistochemical evaluation incorporated both the intensity and distribution of staining into a semiquantitative analysis. Specific staining for ER was observed only in the nuclei of epithelial, stromal and malignant cells. No specific cytoplasmic staining was observed in all paraffin sections. ER-positive staining [histologic score (H-score) > or = 75] was found in 23 (54.8%) of 42 samples and the ER H-Score of cancer components was significantly associated with the histological grade of endometrial carcinomas (P < 0.05). The ER-positive patients tended to have a better prognosis than ER-negative ones. Thus, it may be concluded that the treated formalin-fixed, paraffin-embedded tissues are still suitable for detecting ER by the immunohistochemical method, and the ER content of endometrial carcinomas is useful in indicating the differentiation of cancer and in predicting the patient's prognosis.

Predicting smoking status by symptoms of depression for U.S. adolescents

This study examined the predictive relationships between adolescents' smoking and symptoms of depression. A national sample of 6,900 adolescents, ages 14 to 18 years, were selected for analysis. Variables of interest included measures for smoking status and symptoms of depression. Odds ratio and adjusted odds ratio from logistic regression analyses indicated that more of the 885 smokers than of the 6,015 nonsmokers reported feelings of unhappiness, sadness, or depression, hopelessness about the future, and having trouble going to sleep.

Bronchial arteriography and transcatheter embolization in the management of hemoptysis

PURPOSE

The purpose of this study was to determine the factors influencing the effect of bronchial artery embolization in treating massive hemoptysis and the value of bronchial arteriography in the evaluation of patients with hemoptysis.

METHODS

Thirty-five patients with acute hemoptysis were evaluated by means of bronchial arteriography and treated with transcatheter embolization. Specific causes for bleeding were bronchiectasis (17), lung cancer (9), tuberculosis (4), tetralogy of Fallot (1), and idiopathic hemoptysis (4). The materials used for embolization were gelatin sponge in 33 patients, dextran microspheres in 2, and stainless coils in 1.

RESULTS

The angiographic signs of hemorrhage encountered were extravasation of contrast media (14.2%), hypervascularization (94.5%), bronchopulmonary shunts (34.2%), and bronchial artery aneurysms (14.2%). Immediate control of bleeding occurred in 32 (91.4%) of 35 patients after embolization. The rate of recurrent hemoptysis was 20.0% after 2 weeks of the procedure, but the hemorrhage was less severe than before treatment.

CONCLUSION

The data suggest that bronchial artery embolization is an effective method for managing patients with hemoptysis. Minor bleeding recurrences appear to be relatively frequent.

Transjugular intrahepatic portosystemic stent shunts. Preliminary results in 18 patients

In 18 consecutive patients receiving the transjugular intrahepatic portosystemic stent shunts (TIPSS), 15 were male and 3 female. The patients aged from 34 to 66 years had liver cirrhosis with portal hypertension and esophageal varices. Twelve had recurrent bleedings from raptured gastroesophageal varices. Shunts were established in 16 of the 18 patients and no operative death was noted. Portal vein pressure was reduced from 3.98 +/- 0.24 kPa before shunting to 2.40 +/- 0.16 kPa after shunting. Doppler ultrasound examination revealed that the maximum blood flow velocity in the main portal vein increased from 14.0 +/- 4.5 cm/sec to 48.0 +/- 16.5 cm/sec. The mean follow-up time in the successful cases was 4.5 months (range 2-8 months). The shunt patency was determined with color Doppler ultrasound in 15 patients: occlusion in one and no accites in 4. Varices disappeared in 8 patients and became less evident in 7. No patients had recurrence of varices bleeding or encephalopathy during follow-up. The results suggest that TIPSS is a safe and effective method for portal decompression in the treatment of variceal hemorrhage, and that portal vein puncture is largely dependent on understanding the three-dimensional relationships between hepatic and portal veins. To achieve an adequate portal decompression, we recommend that a stent of 12 mm in diameter be used in severe cases.

Tobacco use among American adolescents: geographic and demographic variations

A previous national study indicated that the South dominated other regions of the United States in tobacco use. Using the results of the Teenage Attitudes and Practices Survey conducted by the National Center for Health Statistics, we examined the geographic and demographic differences of tobacco use among US adolescents. The sample consisted of teenagers in grades 7 through 12 nationwide (N = 6,599). Data were collected through telephone interviewing. The variables included demographics and measures of smoking or use of smokeless tobacco (chewing tobacco/snuff). Results indicated that the overall prevalence rate for smokeless tobacco use was 4.44%, but in the South it was 6.38%. The overall smoking prevalence rate was 13.31%, with no substantial difference among regions. Demographic variables such as sex, ethnicity, education, and poverty levels were also related to tobacco use prevalence. These geographic and demographic variations in tobacco use help target specific regions and populations in greatest need of intervention programs.

Characterizing nutrient intakes of adolescents by sociodemographic factors

PURPOSE

The purpose of this study was to provide a description of the current dietary intake of a large sample of U.S. adolescents and to identify sociodemographic risk factors for nutrient intakes that did not meet recommended levels.

METHODS

The 1987-88 USDA Nationwide Food Consumption Survey was used to assess the nutrient intake of 933 adolescents aged 11 to 18 years. Analysis of covariance was used to determine the effect of the following on the nutrient intakes of males and females: household income and size, race, geographic region, degree of urbanization, and head of household status. Subject age was entered as a control variable.

RESULTS

Vitamin A, vitamin E, calcium, magnesium, and zinc were the nutrients most often consumed below recommended levels. In addition the females consumed low levels of phosphorus and iron. Percent calories from total fat and saturated fat and mean sodium intakes were above recommended levels for the majority of the sample. Females were more likely to meet cholesterol recommendations than males. Race and region affected the most nutrient intake variables. For the females, living in the south was a significant predictor for low intakes of several essential vitamins and minerals.

CONCLUSIONS

On average, the adolescents consumed diets that were low in several essential vitamins and minerals and high in some nutrients related to increased incidence of chronic disease. There were groups of teens who had dietary patterns that placed them at especially high risk, in particular the black and Southern females.

[Transjugular intrahepatic portosystemic stent shunts]

We studied the clinical and procedural results of transjugular intrahepatic portosystemic stent shunts (TIPSS) procedures in 16 patients, of whom 13 were male, 3 female, with mean age of 48 years (range 24-66). All patients had cirrhosis with portal hypertension and varices. Twelve patients had recurrent bleeding for gastroesophageal varices. The results showed that shunts were successful in 14 of the 16 patients, and that no death was due to the procedure. Portal vein pressure was reduced from 3.98 +/- 0.24 kPa before shunting to 2.40 +/- 0.16 kPa after shunting. Doppler ultrasound revealed that the maximum blood flow velocity in the main portal vein increased from 14.0 +/- 4.5 cm/s to 48.0 +/- 16.5 cm/s. The mean follow-up time in the successful cases was 4.5 months (range, 2-7.5). The shunt patency was determined with color Doppler ultrasound in 13 patients, and occlusion of the tract was found in one. Mild ascites resolved in 4 patients; varices disappeared in 7 patients and abated in 6. No bleeding or encephalopathy was noted during the follow-up. The results suggested that TIPSS is an safe and effective method for portal decompression in the treatment of variceal hemorrhage, and that the key to TIPSS is understanding of the 3-dimensional relationships between hepatic and portal veins. To achieve an adequate shunt, we recommend that stent with 12 mm in diameter should be used.

[The study on the relationship between the malocclusion of the third molar and craniomandibular dysfunction]

A total of 33 craniomandibular dysfunction (CMD) patients with third molar malocclusion were studied for their occlusion, condyle position, the TMJ arthrograph and EMG of upper and lower lateral pterygoid muscle (Lpt). The results showed that the condyle displacement was related to the malocclusion of third molar, of which it may induce TMJ click as the result of loss of disccondyle harmonious relationship. Most of the patients showed the abnormal EMG of Lpt. Among which some click TMJ showed no obvious condyle displacement while on the others felt severe pain without TMJ click. It can be considered that both the malocclusion of third molar and dysfunction of Lpt may be the cause of TMJ click.

Incongruence of existing practice management curricula content and actual medical practice need

BACKGROUND AND OBJECTIVES

Practice management is an important, but often overlooked, element of medical training, especially for physicians in primary care. The objective of this study was to evaluate our program's practice management curriculum to determine if it meets the needs of its graduates.

METHODS

A questionnaire, developed and sent to 1986-1991 graduates of the residency program (n = 76), determined their perceptions of how well the practice management curriculum prepared them to operate a practice. Fifty (65.8%) usable surveys were returned.

RESULTS

The respondents perceived deficits in areas of preparing for office management, starting and building a practice, using professional services (especially in the areas of financial decisions and use of professionals), and reimbursement procedures.

CONCLUSIONS

Physicians need an understanding of business fundamentals such as economics, organization management, contract evaluation, negotiation and mediation skills, methods of allocation of limited resources, information science, and consumerism. This article offers a process through which other family practice residency programs can begin evaluating and restructuring their practice management curricula to meet these needs.

Desire for weight gain and potential risks of adolescent males using anabolic steroids

This study examined the perceptions of adolescent males regarding their physical strength, health status, and desire to gain weight and their perceptions of anabolic steroid use. Subjects were 12th-grade boys (N = 3403), drawn from a pool of 150 high schools nationwide, who completed a health questionnaire. Analysis indicated 47.0% (n = 1475) who wanted to gain weight, perceived themselves as of less than average strength and having good health, and were sports participants. Also, among those who desired weight gain, about 24% (n = 345) were not sure about the most dangerous health risks associated with anabolic steroid use, and 16% (n = 221) did not want to see the use of anabolic steroids in sports stopped. The findings indicate that adolescent boys, who desired weight gain and currently abstained from anabolic steroid use, might be at risk for becoming users.

Characterizing nutrient intakes of children by sociodemographic factors

Data from 1,392 children ages 1 to 10, who were participants in the U.S. Department of Agriculture 1987-88 Nationwide Food Consumption Survey, were examined to determine how their diets compared with current dietary recommendations and to identify those sociodemographic factors associated with the greatest risk for not meeting the recommendations. Vitamin A, vitamin E, vitamin C, calcium, iron, and zinc were the nutrients most often consumed below recommended levels. Percentage of calories from fat and saturated fat and mean sodium intakes were above recommended levels for the majority of the children. Of the total sample, 81 percent met guidelines for cholesterol intakes. Multiple correlation regression analysis was used to determine the effect of the following factors on the children's nutrient intakes: geographic region, degree of urbanization, race, household size and income, age, education, and employment status of the male and female head of household. Age and sex of the child were entered as control variables. Level of urbanization affected the most nutrient intake variables, followed by race. Living in a rural area and being black were significant predictors for higher intakes of total fat, saturated fat, cholesterol, and sodium. Mean annual household income had no significant effect on any of the diet quality measures. Many of the children in the sample, however, participated in Federal food and nutrition programs that provided additional resources for food.