A measure of knowledge and confidence in relation to HIV and AIDS: reliability and validity

Knowledge of HIV and AIDS is widely seen as an important determinant of anxiety about such infection in health care workers. However, existing measures of this knowledge suffer from a number of methodological problems and few demonstrate adequate reliability and validity. This paper documents the development of a new measure detailing its reliability and validity. Knowledge, and also confidence in knowledge, were assessed across seven domains of relevant information (e.g. epidemiology, personal risk, symptomatology) in one non-expert group (non-medical undergraduate psychologist) and in three groups with greater expertise (nursing students and third year and final year medical students). The measure was shown to be reliable and to discriminate between the four groups in a manner consistent with the level of education received by each group and in terms of both the scale scores for the seven domains and the individual items. In general, final year medical students were shown to be more knowledgeable, and more confident in their knowledge, than the other groups. The non-medical undergraduates showed the lowest level of knowledge. In general, the groups appeared under-confident in their knowledge about HIV/AIDS. This was interpreted in terms of members of these groups exhibiting caution and the perceived fluctuating nature of the HIV knowledge base. Implications for the training of health care workers in relation to HIV/AIDS are discussed.

Idiopathic intracranial hypertension associated with tetracycline use in fraternal twins: case reports and review

Fraternal twin sisters developed idiopathic intracranial hypertension (IIH) shortly after beginning tetracycline for treatment of acne. We reviewed from the literature 19 familial cases of IIH and 37 cases of IIH associated with tetracycline usage. Among the 37 combined adult and pediatric cases, 26 of 37 had resolution of signs or symptoms of IIH within hours to days of stopping the antibiotic, and rapid recurrence with reinitiation of drug occurred in 4 of 37. We suggest that these cases may be tetracycline-induced, may be related to an underlying genetic susceptibility, and support the notion of multifactorial etiologies for IIH.

Managing health and safety in hospitals

This article is set against the background of recent changes in health and safety legislation which directly affect hospital staff. Research into the central concepts of hazard, risk and harm is contributing to a broader understanding of the management of health and safety. Both occupational medicine and safety practice must recognise the role of psychosocial and organisational processes in managing workplace hazards.

The role of cytokines in the pathogenesis of hepatic granulomatous disease in Schistosoma mansoni infected mice

Cytokines are important in the cell-mediated response to Schistosoma mansoni eggs. We have found that Th2 cytokine responses (e.g. IL-4 and IL-5) are augmented after egg laying begins while Th1 responses (IL-2 and IFN-gamma) are down regulated in S. mansoni infected mice. Treatment of mice with anti-IL-5 monoclonal antibodies (Mab) suppressed the eosinophil response almost completely but did not affect granuloma size and slightly increased hepatic fibrosis. Anti-IL-4 treatment abolished IgE responses in infected mice and decreased hepatic fibrosis slightly. Anti-IFN-gamma treatment had no effect on hepatic pathology. Anti-IL-2 treatment decreased granuloma size significantly and decreased hepatic fibrosis markedly. Anti-IL-2 treatment dramatically decreased IL-5 secretion by splenic cells in vitro and decreased peripheral blood and tissue eosinophilia. In contrast IL-4 secretion was unaffected and serum IgE was normal or increased. IL-2 and IFN-gamma secretion by splenic cells of treated mice were slightly but not significantly increased suggesting that anti-IL-2 treatment is affecting Th2 rather than Th1 responses.

Hormone receptors and cathepsin D levels in human breast epithelial cells transformed by chemical carcinogens and c-Ha-ras transfection

The objective of this work was to determine whether transformation of the human breast epithelial cell line MCF-10F by the chemical carcinogens 7, 12-dimethylbenz(a)anthracene (DMBA) or benzo(a)pyrene (BP), or c-Ha-ras oncogene transfection, influence the expression of epidermal growth factor receptor (EGFR), estrogen (ER) or progesterone (PR) receptors, and the content of cathepsin-D (Cath.D). MCF-10F control cells did not express any of the phenotypes of neoplastic transformation, whereas carcinogen-treated cells and clones derived from the latter formed colonies in agar-methocel, and exhibited increased chemotaxis and chemoinvasion. Clone BP-1E was also tumorigenic in SCID mice. The BP1 cell line transfected with mutated c-Ha-ras oncogene, named BP1-Tras, became more aggressive after transfection and decreased the latency time to tumorigenesis. Radioligand binding and immunocytochemical reactions were utilized for determining the receptors and Cath.D content of control and carcinogen-treated cells and their derived clones. MCF-10F cells contained 37 fmol/mg of protein of EGFR, ER and PR were undetectable, and Cath.D content was 70 fmol/mg protein. EGFR content was significantly higher in D3-1 and BP1-E cell lines vs the control MCF-10F and the other DMBA and BP clones, correlating positively with the emergence of the transformation phenotype. Whereas EGFR levels were not significantly different in BP1-Tras cells when compared with BP1-E, the former were more tumorigenic in SCID mice, an observation suggesting an alternative pathway in these cells in the formation of tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

MRI in cerebellar hypoplasia

Cerebellar hypoplasia may present with a wide variety of neurological and systemic features, ranging from aplasia causing neonatal death to mild hypoplasia in an asymptomatic adult. MRI clearly documents the size of the cerebellum and any associated abnormalities. We describe 7 cases of cerebellar hypoplasia of varying aetiology--3 inherited, 2 associated with spinal dysraphism, 1 with Joubert's syndrome and 1 with pontine agenesis, probably as a result of basilar artery infarction in utero. T1- and T2-weighted images were obtained in each case and gadolinium-DTPA was administered in one. Associated features such as a Chiari malformation (2 cases), brain stem hypoplasia (2 cases), Dandy-Walker cyst and pachygyria (3 cases) and spinal dysraphism (2 cases) were clearly identified. Accurate documentation of these appearances assists in genetic counselling.

Phase I/pharmacokinetic/biochemical study of the nitroimadazole hypoxic cell sensitiser SR2508 (etanidazole) in combination with cyclophosphamide

SR2508 sensitises certain hypoxic tumor cells in vitro and in vivo to the cytotoxic action of radiation and alkylating agents. The mechanism of sensitisation may derive in part from depletion of glutathione (GSH) and possibly inhibition of GSH-dependent enzymes in target cells. We treated 46 evaluable patients with cyclophosphamide 750-1000 mg m-2 followed by SR2508 at eight dose levels ranging from 2.5 to 15.0 g m-2. Each patient received SR2508 as a single agent initially, followed a week later by the combination of cyclophosphamide and SR2508. Initially, myelosuppression was the major toxicity; potentiation of cyclophosphamide-induced leukopenia by SR2508 required a dose reduction of cyclophosphamide to 750 mg m-2 at SR2508 doses above 7.2 g m-2. At doses above 9.4 g m-2 an acute syndrome of muscle pains and painful paresthesias of the extremities lasting 12-24 h was observed to occur with increasing severity. This side-effect was intolerable in two of three patients treated at 15.0 g m-2. The only other reproducible side-effect was nausea and vomiting which was controllable with antiemetics. Plasma and urine SR2508 concentrations were measured by HPLC in 45 patients. Plasma elimination curves fit a 2-compartment model. The mean terminal half-life at each dose level ranged from 5.1-5.8 h. The mean area under the plasma concentration-time curve was linearly related to dose, and mean total body clearance ranged from 46.6-94.0 ml-1 min-1 m-2; renal clearance accounted for 65.7-79.3%. Pretreatment with cyclophosphamide did not influence the kinetics of SR2508 in individual patients. Examination of the glutathione content of peripheral mononuclear cells and tumour samples showed that depletion to below 50% of control occurred in the majority of patients. GSH transferase inhibition occurred with a similar time-course, but to a lesser extent. These data suggest that the further evaluation of this regimen should be conducted with SR2508 administration preceding that of cyclophosphamide and that its evaluation in cyclophosphamide-sensitive tumours is warranted.

Evaluation of growth hormone in thalassaemic boys with failed puberty: spontaneous versus provocative test

Growth hormone (GH) secretion was determined by evaluating ultradian GH profiles for 12 h and GH responses to insulin stimulated hypoglycaemia (ITT) in 28 stunted boys with beta-thalassaemia major aged 15.2-17.4 years, who presented with pubertal failure (FP). Healthy non thalassaemia prepubertal boys (n = 10) aged 7.5-8.8 years, were studied as controls. All patients had normal responses to ITT with peak GH levels > or = 15 mU/l. Basal GH concentrations (mean +/- sem) (1.65 +/- 0.03 mU/l vs 2.58 +/- 0.27 mU/l; P < 0.05) and the stimulated GH responses (peak GH = 15.4 +/- 0.20 mU/l vs 21.08 +/- 0.78 mU/l; P < 0.001) were significantly lower in the patients with failed puberty than in the controls, indicating that the FP patients had diminished GH reserve and secretory capacity. Moreover, all the GH peak parameters including the maximum spontaneous concentrations (MX-GH) and the area under the GH curve (AUC) were significantly lower in the thalassaemic patients than in the controls (MX-GH = 5.2 +/- 0.21 mU/l vs 20.42 +/- 0.14 mU/l; P < 0.001; AUCb = 421.22 +/- 4.31 mU/l vs 712.20 +/- 3.42 mU/l; P < 0.001). These observations suggest that the thalassaemic patients had endogenous neurosecretory GH deficiency (GHND). Priming with sex steroid did not cause any improvement in the spontaneous or stimulated GH secretory patterns in thalassaemic patients. It was noteworthy that in neither the patients nor the control subjects, was there a significant correlation between the maximum stimulated and the MX-GH concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Occupational health: control and monitoring of psychosocial and organisational hazards at work

This paper considers the conceptualizations which underpin the traditional approach to occupational health and offers a critique; much of which points up the importance of psychosocial and organizational issues. It then explores the possible development of a new 3 factor model of concern - organisational health - based on health, work and organisation. It takes as its thesis the need to address the problems posed by psychosocial and organisational hazards at work and the argument that these can be managed effectively within the framework of practice that has proved successful for the more tangible workplace hazards.

Late fetal pontine destruction

A child with an absent pons is described who died 8 weeks after birth. At postmortem examination, the defect was consistent with a vascular event in the last trimester.

MRI in neurofibromatosis 1. The nature and evolution of increased intensity T2 weighted lesions and their relationship to intellectual impairment

Thirty eight patients with neurofibromatosis 1 (NF1) had neurological examinations, intellectual assessments and MRI scans. Increased intensity lesions on T2 weighted images were found in 13 patients. These abnormalities were more common in patients aged under 18 years. The lesions occurred predominantly in the basal ganglia, brainstem and cerebellum, and were multiple in 11 patients. They did not produce symptoms or neurological deficit in any patient and did not enhance with gadolinium-meglumine-triamine-pentaacetic acid contrast medium (Gd-DTPA). In 2 patients, however, the abnormalities exerted mass effect distorting the brain and in 3 patients they occurred in conjunction with known gliomas. The lesions remained unchanged over a three year follow up period. The nature of the lesions is uncertain but the fact that they may produce mass effect and occur in association with gliomas suggests that they have malignant potential. There was no correlation between the presence of these abnormalities and intellectual impairment.

Interference with glycated hemoglobin by hemoglobin F may be greater than is generally assumed

An automated electrophoretic method to measure glycated hemoglobin (Hb A1) was compared with manual affinity methods. Good correlation between methods was found. The electrophoretic method showed good run-to-run precision, good linearity, was free from interference by the labile aldimine fraction, and required less time and considerably less consumable expense than the affinity methods. However, as previously reported, Hb F comigrating with Hb A1 caused spurious increases in glycated Hb levels as compared with the affinity methods. This effect was linearly dependent on the Hb F concentration. Using the discrepancy between concentrations of Hb A1 by electrophoresis and glycated hemoglobin by affinity methods, 330 patients were screened in two hospitals for Hb F. A 12% frequency of elevated Hb F (defined as a level that is more than 2%) was found in patients from a community-tertiary care hospital, which is significantly greater than the 1.5% frequency commonly thought to occur in the adult population at large, whereas patients from a Veterans Administration Hospital showed an elevated frequency of 2.2%. Based on this and other studies, it is concluded that the frequency of elevated Hb F in adults may very substantially among different medical centers. The authors recommend against using this method and suggest that laboratories that persist in using it should periodically assess the frequency in patients with Hb F levels greater than 2% of total hemoglobin, replacing the method if an unacceptably high frequency is found.

Facile preparation of nuclease resistant 3' modified oligodeoxynucleotides

An efficient chemical procedure for the immobilization of carboxylate containing conjugate groups onto controlled pore glass (CPG) is described. The derivatized supports were used in the automated synthesis of an oligodeoxynucleotide (20-mer ODN) containing a 3' phosphodiester linked hexanol, aminohexyl, acridine, or cholesterol group. The stability of the oligomer in a hepatoma cell culture was found to be prolonged two to three fold by the presence of any of the 3' tails. By contrast, an aminohexyl group appended to the 5' terminus of the ODN only marginally improved its nuclease resistance. These data support the notion that antisense ODNs are primarily degraded by 3' exonucleases. Introduction of simple 3' tails which incorporate a normal phosphodiester linkage can increase ODN stability by interfering with these enzymes.

Linkage mapping of the cystathionine beta-synthase (CBS) gene on human chromosome 21 using a DNA polymorphism in the 3' untranslated region

We used single-strand conformation polymorphism (SSCP) to detect DNA polymorphisms in the 3' untranslated (3'UT) region of the gene for cystathionine beta-synthase (CBS). A polymorphism due to a T-to-C substitution at nucleotide 549 of the 3'UT region with heterozygosity of 46% has been identified. Genotypes for this polymorphism have been obtained in all of the informative CEPH families, and CBS has been placed in the linkage map of human chromosome 21.

Cloning and linkage mapping of three polymorphic tetranucleotide (TAAA)n repeats on human chromosome 21

We report the cloning, sequencing, and mapping of three short sequence repeat polymorphisms due to tetranucleotide (TAAA)n repeats from human chromosome 21. These DNA markers (D21S221, D21S225, D21S226) have been cloned from the chromosome 21-specific plasmid library of J. C. Fuscoe, C. C. Collins, D. Pinkel, and J. W. Gray (1989, Genomics 5: 100-109) and were shown to be polymorphic by polymerase chain reaction amplification and polyacrylamide gel electrophoresis. Genotypes were determined in informative CEPH pedigrees and used in linkage analysis relative to other mapped markers on human chromosome 21. One of these markers, D21S221, is closely linked to the amyloid precursor protein gene (APP), which has been implicated in the etiology of familial Alzheimer disease in some families.

Linkage mapping of the AML1 gene on human chromosome 21 using a DNA polymorphism in the 3' untranslated region

We have detected a polymorphism in the 3' untranslated region of the AML1 gene, which is located at the breakpoint on chromosome 21 in the t(8;21)(q22;q22.3) translocation often associated with patients with acute myeloid leukemia. Informative CEPH families were genotyped for this polymorphism and used to localize the gene on the linkage map of human chromosome 21. The AML1 gene is located between the markers D21S216 and D21S211, in chromosomal band 21q22.3.

Linkage mapping of the carbonyl reductase (CBR) gene on human chromosome 21 using a DNA polymorphism in the 3' untranslated region

A DNA polymorphism has been found in the 3' untranslated region of the carbonyl reductase gene (CBR). Genotypes of the members of the CEPH pedigrees have been obtained and used in linkage analysis to map the CBR gene in the linkage map of human chromosome 21. The gene maps between the interferon-alpha receptor (IFNAR) and the D21S55 loci.

The evaluation of patients with a suspected pituitary microadenoma: computer tomography compared to magnetic resonance imaging

OBJECTIVES

To perform a prospective study to compare the ability of magnetic resonance imaging (MRI) and computer assisted tomography (CT) to predict the position of a tumour within the pituitary fossa and to assess the clarity of the image generated by the two modalities in patients with suspected pituitary microadenomas.

DESIGN

Nineteen patients were investigated with CT and MRI scans and underwent trans-sphenoidal exploration of the pituitary fossa. Both scans were assessed blind and independently by three neuroradiologists, A, B, and C; A and B examined the CT scans and B and C the MRI scans. The predicted site was then compared to the size and position of the tumour at surgery.

PATIENTS

Twenty-five patients were recruited and had both CT and MRI scans, 19 subsequently underwent trans-sphenoidal exploration of the pituitary fossa and formed the study population.

RESULTS

The joint opinions of A and B of the CT scans were correct in 10/19, and those of B and C of the MRI scans were correct in 17/19 cases, P = 0.008. Observer agreement was used to assess the clarity of the image. A and B agreed about the site of the tumour on the CT scan in 14 of 19 cases (Kappa statistic 0.556); B and C agreed on the MRI scans in 19/19 cases (Kappa statistic 1), P = 0.025. After the exclusion of five cases found to be macroadenomas at surgery, the joint opinions of A and B of the CT scans were correct in 8/14, and those of B and C of the MRI scans were correct in 12/14 cases, P = 0.133. A and B agreed about the site of the tumour on the CT scan in 12/14 cases (Kappa statistic 0.653), B and C agreed on the MRI scans in 14/14 cases (Kappa statistic 1, no significant difference).

CONCLUSIONS

In the assessment of suspected pituitary microadenomas MRI is the imaging technique of choice in view both of its greater diagnostic accuracy and the avoidance of radiation exposure.

Detection of hereditary haemochromatosis in an HLA-identical pedigree showing discordance between HLA class I genes and the disease locus

Hereditary haemochromatosis is a recessive disease in which primary hepatocellular carcinoma, complicating cirrhosis, is responsible for about one-third of deaths in affected homozygotes. We describe a unique HLA haplo-identical pedigree showing parent-to-offspring transmission of hereditary haemochromatosis in whom HLA typing studies, including class I and class II allogenotype analysis, were of no benefit in identifying affected homozygotes. However, affected siblings in the pre-cirrhotic stage of haemochromatosis, with apparent discordance between the haemochromatosis allele and class I loci on chromosome 6, were detected by undertaking a family study, using analysis of serum parameters of iron status in combination with magnetic resonance imaging (MRI). This pedigree emphasises the critical importance of genetic and non-invasive methods for the identification of asymptomatic homozygotes before cirrhosis develops.

Ion channels in boar sperm plasma membranes: characterization of a cation selective channel

Plasma membranes isolated from cauda epididymal and ejaculated boar sperm were inserted into planar lipid bilayers and examined for the presence of ion channels. Channel fusion was frequently observed; the most prominent was a nonselective cation channel which conducted K, Na, Cs, Ca, and Ba. Channel opening did not show a strict dependence on voltage but was partially blocked by verapamil, nitrendipine, and ruthenium red. A channel with these characteristics was observed when plasma membranes were isolated by high-pressure nitrogen cavitation (650 psi, 78% sperm head plasma membranes) or at very low nitrogen pressures (50 psi, 90% sperm head plasma membranes), suggesting that this channel may be present in the plasma membrane overlying the sperm head.

Risk factors for immediate prosthetic postmastectomy reconstruction

The charts of 44 women who underwent 47 immediate postmastectomy prosthetic breast reconstructions (IPMPBR) with subpectoral prostheses (long-term implant, long-term expandable implant or tissue expanders followed by long-term prosthetic placement) were retrospectively reviewed. Follow-up was from 3 to 49 months (median 18 months). Patient ages ranged from 31 to 77 years (median 42) but 82 per cent were under 60 years old. Indications for mastectomy were infiltrating cancer in 30 patients, intraductal cancer in 11, lobular carcinoma in situ in two and prophylaxis in one. There were 11 patients with pathologic Stage I, 15 with Stage II, three with Stage III and one with Stage IV breast cancer. Adjuvant chemotherapy (CTX) was given to 17 women, adjuvant hormonal treatment to nine, and radiation therapy (RT) to five. One patient had prosthesis extrusion and removal. Two patients had late periprosthetic infections (PPI) with consequent prosthesis removal. CTX did not have a significant association with PPI (two of 14 with CTX vs 0 of 29 without, P = 0.1). However, fill port migrations, prosthesis deflations, and greater than 1 complication were significantly associated with these infections (two of three vs 0 of 38, P = 0.004; two of two vs 0 of 45, P = 0.001; two of four vs 0 of 43, P = 0.006). Skin flap cellulitis and postoperative seroma were also associated with PPI (P less than 0.003 and less than 0.006, respectively). These factors were all also significantly associated with involuntary prosthesis loss (n = 3).(ABSTRACT TRUNCATED AT 250 WORDS)

Multi-institutional drug-use evaluation of intraocular irrigating solutions

A collaborative drug-use evaluation (DUE) of intraocular irrigating solutions (IOISs) at ophthalmic specialty hospitals nationwide is reported. Qualifying criteria for the use of an expensive fortified IOIS product were (1) the duration of surgery is more than 60 minutes, (2) the surgery is performed without a viscoelastic agent, (3) the patient's age is less than 50 years, (4) the patient has diabetes, and (5) the patient has evidence of compromised corneal endothelium. Surgical cases involving the use of IOISs were identified at each institution, and those cases involving fortified IOIS were reviewed for conformance with the criteria established. Of 23 institutions, 10 were able to perform the DUE. The review was concurrent at one institution and retrospective at the other nine. A case had to meet only one criterion to be considered in conformance. The cumulative mean rate of conformance with at least one criterion was 74%; the median conformance rate was 91%. The criteria that most frequently justified the use of fortified IOIS were surgical duration and nonuse of a viscoelastic material. Conformance with the DUE criteria varied with the institution, but valuable knowledge about the use of intraocular irrigating solutions was obtained by all.

Cognition and mood in relation to the performance of squash tasks

The purpose of this investigation was to determine the role of cognition and mood in the performance of squash tasks, with particular reference to attention and self-reported arousal and stress. Volunteer male subjects (n = 40), divided into three ability groups, 'skilled', 'average' and 'novice', were required to perform two squash tasks with different degrees of difficulty. Order of presentation of the tasks was controlled. Results indicated that subjects completing the easier squash task first performed better on the subsequent difficult task than those subjects who completed the more difficult task first. No differences in scores across tasks were found for subjects completing the tasks in reverse order. Performance was related to level of skill. Furthermore, significant differences in attentional style were revealed when average subjects were compared with skilled and novice players. Skilled players were also found to exhibit significantly different personality characteristics from novice players. Specifically, skilled players exhibited higher levels of extraversion and appeared less neurotic. For the average and novice groups, reports of high levels of stress accompanied those of high levels of arousal and these remained constant throughout the experiment. By contrast, for the skilled group low levels of stress accompanied high levels of arousal. The results are discussed in terms of the effects of these cognitive and mood factors on performance and a suggested direction for future research is offered.

Do subjects with stiff arteries have high blood pressure?

It has been argued that age-related increases in arterial stiffness could lead to spuriously high indirect blood pressure measurements, with consequent overdiagnosis of hypertension in older patients. To study the relationship between arterial stiffness and blood pressure, we identified patients with 'arterial stiffness', using Osler's manoeuvre, and compared their blood pressure levels with patients of a similar age. A total of 250 hospital inpatients were assessed independently by two doctors. In the 198 patients (79%) where both observers agreed on Osler's manoeuvre status, positive Osler's manoeuvre was uncommon under the age of 50 years but became more common thereafter, rising to 58% of patients aged over 75 years. However, blood pressure levels were similar in each age group, irrespective of Osler's manoeuvre status. We conclude that increased arterial stiffness as measured by Osler's manoeuvre is not necessarily associated with raised blood pressure levels in the elderly.

Lymphokine-activated killer function following autologous bone marrow transplantation for refractory hematological malignancies

Disease recurrence remains the major factor which limits the success of autologous bone marrow transplantation (ABMT) for refractory hematological malignancies. The administration of interleukin 2 (IL2) with or without ex vivo generated lymphokine-activated killer (LAK) cells represents a potential approach to eradicating residual disease after ABMT. However, since LAK precursor activity is radiosensitive, high dose chemoradiotherapy may abrogate LAK function and preclude clinical responsiveness to IL2 after ABMT. Furthermore, since lymphocyte subsets which mediate LAK activity may recover at different rates after ABMT, LAK cells may be phenotypically and/or functionally altered after ABMT. To determine whether IL2 responsive LAK precursor cells are present in the circulation after ABMT, peripheral blood mononuclear cells (PBMC) from 21 patients with acute leukemia or lymphoma were tested for IL2-inducible LAK activity 17-83 days after ABMT. Cells were cultured with IL2 (1000-2000 units/ml) for 4 or 5 days and then tested for cytolytic activity and/or cell phenotype. LAK activity against the Daudi cell line was detected in every PBMC sample from every patient at every time point tested. The Raji cell line and a fresh allogeneic ovarian carcinoma were also lysed by LAK cells generated after ABMT. In the subgroup of patients transplanted for non-Hodgkin's lymphoma, LAK precursor activity appeared comparable to that of healthy controls. Culture with IL2 resulted in increased mean IL2 receptor expression in lymphocytes from patients after ABMT (3.1-9.9%) and from healthy controls (3.1-12.0%). After culture with IL2, the percentage of cells bearing the natural killer cell-associated Leu-19 determinant was significantly higher in patient PBMC than in normal control PBMC (28.3 versus 8.7%). Positive and negative cell selection by fluorescence sorting after culture with IL2 revealed that most of the LAK activity after ABMT was mediated by the Leu-19+ cells. Although CD5+ T-cells were devoid of LAK activity, a subset LAK effectors was CD8+. Thus, LAK activity is rapidly reconstituted after ABMT and is mediated by cells phenotypically similar to those in normal controls. These results support the feasibility of IL2 +/- LAK as consolidative immunotherapy after ABMT.

Identification of calcium conducting channels in isolated boar sperm plasma membranes

Ion channel recordings were obtained from liposomes containing purified boar sperm plasma membrane proteins using a tip-dip method. Liposomes prepared in HEPES-TRIS and clamped by electrodes containing Ba-HEPES displayed channel activity that was partially inhibited by verapamil or nitrendipine and completely inhibited by La3+. Reversal of current at pipette negative voltages was observed only when Ba2+ ions were also present in the bath solution. These data indicate that channels capable of carrying calcium currents are prominent components of the plasma membrane of mammalian sperm.

Separation of synthetic cycloalkylated bases, nucleosides and nucleotides by reversed-phase high-performance liquid chromatography

Reversed-phase high-performance liquid chromatography was used to determine the elution profiles of a series of synthetic cycloalkylated bases, nucleosides, and their corresponding 5'-monophosphates. A 70% aqueous methanol solution proved to be the most efficient solvent system for the separation of a mixture of the bases, all of which were eluted in times ranging from 3.3 to 4.8 min at a flow-rate of 0.8 ml/min. Subsequently, the same percentage of methanol solvent, at 0.8 ml/min, eluted the nucleoside mixture as well, with retention times ranging from 3.3 to 5.0 min. Optimum separation and resolution were achieved with 70% methanol at a flow-rate of 0.6 ml/min for a mixture of the base and nucleoside series. A phosphate buffer, containing acetonitrile-tetrabutylammonium ion, was used to analyze the 5'-monophosphate derivatives. Elution times ranged from 2.6 to 6.1 min at a flow-rate of 1.0 ml/min. Three variables were considered in order to determine optimum conditions for separation and resolution: (a) the percentage of methanol in the solvent; (b) flow-rate of solvent; and (c) the size of the cycloalkylated group of each synthetic analogue. The procedures and conditions described herein have potential use as a monitoring system to detect modified nucleic acid derivative which are prevalent in the body fluids of patients with certain metabolic disorders.

Effects of telic dominance and metamotivational state on squash task performance

Measures of telic dominance and metamotivational state were obtained from 40 volunteer males grouped on the basis of their playing ability, before and after the performance of squash tasks. Utilising a mixed-blocks design, which controlled for order of task, subjects were required to perform two squash tasks of differing difficulty. Significant differences between groups on performance were obtained, confirming the ability classification, but no significant differences in telic dominance were found. Significant increases in mood response in the telic direction were found on pre- and posttask scores. A significant decrease in discrepancy scores (preferred arousal minus felt arousal) obtained pre- and posttask was noted, together with a significant interaction between skill level and in arousal discrepancy pre- and posttask. In all cases trends were least for the most skilled group.

Neurohumoral mechanisms and left ventricular hypertrophy: effects of hygienic therapy

To determine the effects of hygienic (non-drug) therapy on blood pressure (BP) control and its relationship to sympathetic tone and left ventricular mass (LVM) in primary hypertension, plasma norepinephrine (NE) and renin activity (PRA), LVM, and nutritional and behavioral status were assessed in 76 borderline to mild hypertensives. Pretherapy plasma NE was related to diastolic blood pressure (DBP) and PRA (r = 0.24, P less than .05 and r = 0.37, P less than .01, respectively). Plasma NE of high renin patients (221 +/- 52) (mean +/- SD) was greater than that of normal renin patients (159 +/- 61, ng/l, P less than .01). LVM was related to systolic blood pressure (SBP) (P less than .001), DBP (P less than .01) and urinary sodium (P less than .05), and inversely related to PRA (P less than .01). Septal wall thickness was related to hostility (r = 0.42, P less than .05). After seven weeks of hygienic therapy, DBP was reduced by 6 mmHg (P less than .01). The change in SBP was related to baseline plasma NE (P less than .05) and inversely related to LVM (P less than .05). These results suggest that raised sympathetic tone may be a pathogenic factor in primary hypertension and that hygienic therapy lowers BP more effectively in patients with raised sympathetic tone and low LVM.

Factor II, VII, IX and X concentrations in patients receiving long term warfarin

Using standard one stage clotting assays the concentrations of factors II, VII, IX and X were determined in 37 patients stabilised on warfarin for between three months and 17 years. Contrary to popular belief, the concentrations were not equally depressed, with factor X the lowest, factor II at intermediate value, factors VII and IX the highest. Some 71% of the variance of the British corrected ratio (BCR) could be accounted for by measurement of the factors assayed. Analysis of this variance showed 91% of the explained variance attributable to factor II, 7% to factor VII, 1.6% to factor IX and 0.4% to factor X. With the sudden and recent withdrawal of human thromboplastin, investigation of the sensitivities of the animal thromboplastins to changes in vitamin K dependent factors in orally anticoagulated patients is needed to ensure that the potentially alarming falls in factors II and X in these patients are being adequately detected.

Recurrent sterile meningitis caused by a pituitary abscess

The case of a 21 year old woman who presented with recurrent sterile meningitis and bitemporal hemianopia is described. Computed tomographic scan showed a large low density ring enhancing lesion above and within the pituitary fossa which at operation and on histological examination was found to be compatible with an abscess. The visual field defect recovered completely and the scan appearances returned to normal postoperatively.

Psychological and physiological reactions to visual representations of war

This paper explores the immediate psychological and physiological effects of aversive visual stimuli, represented as pictures of war, in a balanced mixed design (n = 24). The moderating effects of individual differences in locus of control and sex were examined, along with those of a requirement to report on the stimuli presented. The results indicated a fractionation of the autonomic response with electrodermal measures (EDA) and salivary function showing a sympathetic type response to war slides whilst measures of cardiac activity (heart rate and heart rate variability) tended to show increased parasympathetic activity over the response to neutral slides. Psychological measures showed an increase in self-reported stress, higher disturbance ratings and unprompted reports of various coping strategies (postexperimental interviews) in response to war slides. Additionally, self reported arousal and EDA's proved sensitive to the report requirement and cardiac activity appeared to be tied to individual differences in terms of locus of control. Although the physiological results could be taken as congruent with Hare's (1972) suggestion that 'morbid curiosity' accompanies the viewing of aversive stimuli, psychological measures tended to disconfirm this interpretation. The situational determinants of the cardiac response are discussed as a solution to the paradoxical cardiac response elicited with aversive visual stimuli, along with individual styles of coping with aversive situations which may be reflected in individual's locus of control.

Smoking behaviour under conditions of relaxation: a comparison between types of smokers

Smoking behaviour, self-reported mood and cardiac activity were examined in 12 "sedative" and 12 "stimulant" smokers, defined using Mangan and Golding's questionnaire. This concerns the interaction between urge to smoke and external situation. "Sedative" smokers appear to experience their greatest need to smoke in situations characterized by low arousal; "stimulant" smokers in situations of high arousal. Members of each group were examined in two low arousal conditions. In one condition smoking was allowed, and in the other it was not. When allowed to smoke, it was shown that the two groups differed in their smoking behaviour: 10 stimulant but only 2 sedative smokers chose to do so. However, although smoking caused a significant increase in cardiac activity in smokers, no effects on subjective arousal were found. The implications of these findings are discussed.

The measurement of self-reported stress and arousal

This paper provides further discussion on the measurement of mood using self-report inventories. It comments on questions raised by Cruickshank (1984) about the structure and use of the stress-arousal checklist developed by Mackay and Cox (Mackay et al., 1978).

Converging and diverging beliefs about arthritis: Caucasian patients, Spanish speaking patients, and physicians

Ninety-eight Caucasian patients, 46 Spanish speaking patients, and 50 physicians (mainly rheumatologists) took part in surveys of salient beliefs about arthritis and its treatment. The beliefs of Caucasian patients and those of physicians were similar. However, beliefs of physicians about patients' beliefs and actual patient beliefs diverged as did the beliefs of Caucasian and Spanish speaking patients. These results suggest that arthritis education and treatment should be based on patients' perceptions rather than on physicians' beliefs about patients' perceptions.