Collagen in naturally occurring hypertrophied porcine myocardium

A comparison of the collagen network in three dimensions was conducted in 8 hypertrophic cardiomyopathy (HCM)-affected and 8 normal hearts. All these hearts were obtained from male and age-matched pigs of the same breeding farm under identical feeding conditions. The selection of HCM-affected heart was based on the abnormal histologic features such as marked disorientation of muscle cells, thickening of the intramural coronary arterial wall with a narrowed lumen, endocardial fibrosis, and myocardial fibrosis. Mean values of heart weight and ratio of heart to body weight of HCM group were significantly (p < 0.01) increased by 36% and 47%, respectively, but not the body weight, as compared to those of the normal group. The scanning electron microscopic (SEM) investigation demonstrated that collagen weave, struts, and strands appeared more numerous in HCM-affected myocardium than in normals. Moreover, the tendons of collagen in HCM-affected myocardium showed increases in both numbers and thickness.

Adequacy of prenatal care of urban high school students

Relationships of five selected variables to the adequacy of prenatal care of pregnant students in urban public high schools were studied. These five variables were: the age of the baby's father, mother's education, parity, living arrangement, and functional areas of support. From 1986 to 1989, a convenience sample of 244 African American, unmarried, pregnant students completed a prenatal questionnaire. The Resource Size scale, a subscale in the questionnaire, was tested on pregnant students, and its coefficient alpha for internal consistency was .86. Additional data were obtained from the state's live birth certificate tape. Results showed that the age of the baby's father was significantly associated with adequacy of prenatal care. Because 51% of the babies' fathers are age 15-19 and most likely in school, the community and school health nurses may encourage them to get involved in the care of pregnant students. Other implications are also drawn.

Family and community support for urban adolescent mothers

The family and community support of adolescent mothers who returned to school was described. One hundred and nine African American, unmarried, primiparous, postpartum students, enrolled in 20 public high schools of a large midwestern city from 1986 to 1989, completed the questionnaire. The Cronbach alpha for internal consistency was .90 for the Resource Size Scale. Results showed that (a) the support from professionals in community agencies was less frequently mentioned by the postpartum students than support from the family, (b) more than 20% of the students had no one available to provide positive feedback and assist with household tasks, (c) the student's mother and the baby's father were most involved in providing support, but differed by support functions, and (d) the baby's father's family was involved in providing support. The school nurses and other professionals need to assist adolescent mothers in seeking support from both the family and the community systems.

Teen voices on a proposed telephone health service

The purpose of this study was to elicit information, feelings, and perceptions of middle and high school students concerning a proposed telephone service for adolescents. Sixteen boys and 33 girls were recruited from six schools. Debriefing summaries from nine focus group sessions were analyzed. Most participants had access to a telephone and privacy during phone calls. Overall response to the proposed telephone service was favorable. The participants voiced needs for evening and night service hours, minimal or no service charges and skilled and caring operators. They also suggested catchy names and marketing strategies for the telephone service. Implications for designing a telephone service for adolescents were drawn.

Pharmacological evidence for a lack of role for protein kinase C in staurosporine-induced morphological changes in embryonic Xenopus myocytes

Staurosporine, an inhibitor of protein kinases, induced outgrowth of cultured embryonic Xenopus myocytes. The outgrowing membrane elicited by staurosporine was stained uniformly with fluorescein isothiocyanate-phalloidin. Pretreatment with microfilament-disrupting agents but not microtubule inhibitors inhibited staurosporine-induced membrane outgrowth. Microfilament assembly is thus required for the action of staurosporine. Protein kinase C activators did not antagonize the membrane outgrowing effect of staurosporine. Furthermore, none of H-7 (1-(5-isoquinolinesulfonyl)-2-methylpiperazine dihydrochloride), H-8 (N[2-(methylamino)ethyl]-5-isoquinoline sulfonamide), sphingosine, phloretin, genistein or calmidazolium induced any significant morphological changes of embryonic myocytes, indicating that tyrosine kinases, protein kinase C, protein kinase A or calmodulin-dependent protein kinases may not be involved in the membrane outgrowing action of staurosporine. Total protein content of myocytes was not altered by staurosporine and protein or RNA synthesis inhibitors did not inhibit the membrane outgrowth induced by staurosporine. Furthermore, membrane outgrowth induced by staurosporine was less pronounced in older cultured myocytes or myocytes acutely isolated at later stages of tadpoles, indicating that there is different developmental susceptibility to the action of staurosporine.

Microcystic adnexal carcinoma. Ten cases treated by Mohs micrographic surgery

BACKGROUND

Microcystic adnexal carcinoma is a slow-growing, nondescript, locally aggressive, deeply infiltrating neoplasm histologically characterized by an infiltrative pattern of basaloid or squamous cells, a desmoplastic stromal reaction, keratin-filled cysts, and glandular structures.

OBJECTIVE

Microcystic adnexal carcinoma is uncommon and may be mistaken microscopically for other benign and malignant entities. Perineural or intraneural involvement by tumor cells is characteristic and extension into underlying structures including muscle, fat, and bone are frequently encountered. Although local recurrences are common after standard surgical excision, metastases have not been reported. Extensive resections of lesions may be necessary to extirpate widespread tumor, particularly those that are long standing or recurrent. Because significantly increased morbidity is associated with recurrent disease, surgical and histopathologic techniques that stress examination of all margins are advantageous.

METHODS

We review the course of 10 patients with microcystic adnexal carcinoma of the face (six primary and four recurrent lesions) and their treatment by Mohs micrographic surgery.

[The effect of cyclooxygenase and thromboxane synthetase inhibition on oxygen metabolism in canine acute respiratory failure]

The purpose of this study is to evaluate the effect of cyclooxygenase inhibitor and thromboxane synthetase inhibitor on oxygen metabolism in acute respiratory failure. Acid aspiration was induced in 18 dogs. Six dogs were pretreated with ibuprofen (IBU), six with OKY-046 (OKY), and the remaining six used as control. After acid aspiration oxygen delivery (DO2) fell in all groups as a result of decreased PaO2 and cardiac output. However, oxygen consumption (VO2) was maintained in all animals by the end of the experiment except in the control group. Arterial oxygen content was maintained at baseline level throughout the experiment in IBU group. Meanwhile a significantly decreased mixed venous oxygen tension was found in OKY group after acid challenge. Linear regression of VO2 and DO2 was confirmed in both the control and OKY groups. However, the dependent relationship between VO2 and DO2 was not identified in IBU group; this may indicate that the body oxygen metabolism was maintained rather well in acute respiratory failure dogs treated with ibuprofen.

[Study on omeprazole 20 mg twice weekly in prevention of duodenal ulcer relapse]

The aim of this study is to propose a regimen of omeprazole 20 mg twice weekly for the prevention of duodenal ulcer (DU) relapse. 257 endoscopically verified DU patients entered this study. They were divided into four groups: (1) Group A, 68 patients stopped treatment after healing of DU during treatment of cimetidine 800 mg at night. (2) Group B, 72 patients healed DU after treatment of omeprazole 20 daily. Then anti-ulcer drug was withdrawn. (3) Group C, after healing of DU, 54 patients received a maintenance dosage of cimetidine 400 at night for up to 1 year. (4) Group D, after healing of DU, 63 patients received omeprazole 20 mg twice weekly (every Monday and Thursday) for up to 1 year. All the patients were followed in out-patients department for assessment of symptomatic response and side effect. Endoscopic examination were performed in those patients when any symptom related to the upper gastrointestinal tract appeared. The cumulative recurrence rates of Group A to Group D at 6 months were 44.1%, 23.6%, 22.2% and 4.8%, and that at 12 months were 76.5%, 36.1%, 27.8% and 6.3% respectively. The relapse rate of patients with omeprazole 20 mg twice a week was significantly lower than that of other groups at either 6 or 12 months. In patients with maintenance therapy of cimetidine, DU recurred more rapidly among smokers than nonsmokers, but there is no significant difference between smokers and nonsmokers receiving maintenance therapy of omeprazole.(ABSTRACT TRUNCATED AT 250 WORDS)

An overview of the development and refinement of the Resource-Based Relative Value Scale. The foundation for reform of U.S. physician payment

Responding to distortions in payment rates between services, policymakers in the United States have sought a systematic and rational foundation for determining physician fees. One such approach to paying physicians, the Resource-Based Relative Value Scale (RBRVS), determines fees by measuring the relative resource costs required to produce them. On January 1, 1992, the Medicare program implemented a new payment system for physician services based on the RBRVS. This article provides a brief history of the RBRVS and a summary of the methods and data used to derive it. This overview represents the culmination of 6 years of research by the Harvard RBRVS study team and provides a road map to the study's concepts and definitions. The overview also provides a context for the articles in this issue that describe five major studies undertaken since 1988. The study's overall results are presented in the last article of the series.

Factors influencing visits to school nurses by pregnant adolescents

The influence of five factors on the first visit to school nurses by pregnant adolescents and adequacy of prenatal care was analyzed. Only one factor, age of baby's father, was found to be associated with adequacy of prenatal care.

Effects of a school nurse prenatal counseling program

To determine the effects of a school-based, nurse-run prenatal counseling program, records of prenatal care visits of students and their infants' birth weights (i.e., cases) were obtained from the state live birth certificate tape for 1985-1987. From the same tape, a mother residing in the same community but not enrolled in the program was matched with each case on eight criteria to serve as a control. A total of 288 matched case-control pairs were obtained. Using McNemar's test, a significantly higher percentage of the cases received adequate prenatal care than did the controls.

[Protective effect of colloidal bismuth subcitrate on gastric mucosal lesion induced by aspirin]

This study was designed to investigate the protective effect of colloidal bismuth subcitrate (CBS) on aspirin-induced gastric mucosal lesion 20 patients with arthralgia were allocated into this study. All of them were free of gastrointestinal symptom and their gastric mucosa were nearly normal under gastroendoscopic observation. The first group of 10 patients received orally aspirin 1.5 qid for 4 days. The second group also of 10 patients was treated with CBS 120 mg qid and after 2 days they received aspirin and CBS simultaneously in the dosage mentioned above for another 4 days. Before and after treatment, the patients of both groups were examined endoscopically. After treatment, the mucosal inflammation was much less in the second group than that in the first group. The prostaglandin E2 concentration of antral mucosa in the first group was reduced significantly after administration of aspirin alone, while that in the second group was slightly increased after a combined treatment of aspirin and CBS. The results demonstrate that CBS is an effective agent in prevention of gastric lesion induced by aspirin and prostaglandin E may be involved in this mucosal protective effect.

Bulimia nervosa and associated alcohol abuse among secondary school students

Four adolescent student populations (totalling 686 girls and 705 boys) completed confidential questionnaires (98.6% response rate) concerning bulimia nervosa and alcohol abuse. All of the DSM-III-R criteria for bulimia nervosa were met by 2.0% of the girls and 0.1% of the boys. On the basis of score greater than or equal to 42 on the Adolescent Alcohol Involvement Scale, 12.5% of all girls and 9.2% of all boys were alcohol abusers. Our results suggest a significant association between bulimic behavior and alcohol abuse in this female population. Other factors associated with bulimic behavior included high maternal vocational status, high socioeconomic class (girls only), high weight for age and height, and low personal ideal weight. Other factors associated with alcohol abuse included high maternal vocational status, low paternal vocational status and education, low socioeconomic class (boys only), low grade point average, high age, and high birth order.

[Omeprazole in peptic ulceration: acid inhibition and endoscopic healing]

Basal and pentagastrin stimulated gastric acid secretions were measured in 20 patients with duodenal ulcer before and after one week of treatment with oral omeprazole 20 mg daily. Omeprazole markedly inhibited gastric acid secretion in all the patients. The mean basal intragastric pH rose from 1.6 to 6.3, and the BAO and MAO were reduced by 86.9% and 83.9% respectively on day 7 of the study. We also conducted a clinical trial in 63 duodenal and 12 gastric ulcer patients. Each patient received 20 mg omeprazole. 98% of the patients were free of pain within first week of the treatment. After 2, 4 and 6 weeks of treatment, the healing rates of duodenal ulcer were 81.3%, 96.8% and 100% respectively, and those of gastric ulcer were 50%, 91.7% and 100% respectively. The drug was well tolerated and no side effect was observed.

Management of retroperitoneal sarcomas

The records of 116 adult patients who underwent operative treatment for retroperitoneal sarcomas at the Mayo Clinic during the years 1963 to 1982 were reviewed. Clinical, pathologic, and treatment variables were analyzed for their influence on recurrence and death from disease. Leiomyosarcomas, liposarcomas, and malignant fibrous histiocytomas represented 93% of the tumors. The primary tumor was completely excised in 54% of patients. Recurrent tumor developed in 68% of patients (median time to recurrence, 1.3 years). Tumor fixation to adjacent structures (T3 tumor) or a high-grade tumor (G2-4) identified patients at increased risk for recurrent disease. Five-year and 10-year survival rates were 40% and 22%, respectively. Survival was significantly better for patients who had (1) complete surgical excision of their tumors, (2) low-grade tumors (G1), (3) tumors not fixed to adjacent retroperitoneal structures (T1 and T2 sarcomas), and (4) tumors without metastases when initially seen. Complete surgical excision offers patients with retroperitoneal sarcomas the best chance for long-term survival, but recurrent disease remains a vexing problem. The therapeutic challenges in the treatment of retroperitoneal sarcomas continue to be the development of therapy that will increase the rate of complete resection, decrease the rate of local recurrence, and enhance patient survival.

Effect of electro-acupuncture of "Neiguan" on spontaneous discharges of single unit in amygdaloid nucleus in rabbits

In this paper, the regularity on spontaneous discharges of the single unit in amygdaloid nucleus (AMYG) in rabbits were analyzed and whether the signal of Electro-acupuncture (EA) at Neiguan (P 6) can reach the AMYG was further observed with the technique of glass microelectrode. It was found that the signals of EA at Neiguan can reach AMYG and activate or inhibit the electrical activity of some neurons, manifesting two response patterns: frequency-increasing and frequency-decreasing. Additionally, the same neuron had a different response to the signals of EA at Neiguan and Zusanli (St 36), suggesting that a relative specificity of acupoints is present.

The effectiveness of public health nursing services to prenatal clients: an integrated review

The effectiveness of public health nursing interventions with prenatal clients was summarized from 17 studies, conducted between 1963 and 1988, that were identified through a comprehensive reference search. The review indicated that public health nursing interventions can increase birthweight, and the use of prenatal medical services, nutritional services, and childbirth classes. Because of methodological problems, however, it is difficult to conclude with certainty that such interventions make a significant difference in client outcomes. These problems included lack of construct validity, lack of specification of interventions, small convenience samples, lack of power to detect small treatment effects, nonexperimental research designs, lack of reliability information, and self-selection and history biases. To overcome these problems, the authors suggest the use of conceptual frameworks, power calculations prior to initiation of research, experimental or quasiexperimental designs, replication of research with different populations, and the calculation and reporting of reliability information.

Development of a public health nursing quality assessment measure

The Ervin Quality Assessment Measure (EQAM) is a newly developed instrument that assesses the quality of in-home public health nursing care based on experts' reviews of client/family records. The 14 criteria for quality care included in the EQAM instrument were established based on the input of five nurse experts. A generalizability study of data from EQAM evaluations of 52 client/family records found that the instrument demonstrated a high degree of dependability and a modest degree of interrater agreement. Future studies will examine the usefulness of the EQAM in home health care agencies and possible practical applications of this research instrument.

Gastrin and somatostatin cells in dyspeptic patients with and without duodenal ulcer: a quantitative study based on multiple biopsy specimens

The numbers of immunoreactive gastrin and somatostatin cells in gastric and duodenal mucosal biopsy specimens from dyspeptic patients with duodenal ulcers and dyspeptic controls without ulcers were calculated using a morphometric method. The levels of gastrin and somatostatin in the tissue were also measured by the radioimmunoassay. The results showed no significant difference in the number of G cells and the level of gastrin in the tissue between the ulcer and non-ulcer groups. However, the number of D cells and the level of somatostatin in the tissue in ulcer patients were remarkably reduced in comparison with those in non-ulcer patients (P less than 0.01 and P less than 0.05, respectively). The G:D cells and gastrin:somatostatin ratios in ulcer patients were much higher than those in the non-ulcer control group. It is considered that the reduction of D cells and the relative lack of somatostatin in duodenal ulcer patients might have a role in the mechanism of the duodenal ulceration.