Graphical displays

This paper selectively reviews the field of scientific and medical graphics. Examples are provided using world health statistics and several new methods of presenting multivariate data are introduced.

A COLLABORATIVE MODEL: Ambulatory Pharmacotherapy for Chronic Psychiatric Patients

1. Increases in patient acuity and diagnosis related groups limiting hospital lengths of stay have contributed to the heightened demand for structured outpatient programs. 2. The Medication Clinic and Medication Group, a daily functioning outpatient program, is designed to shift the responsibility for medication management from the health-care provider to the patient and family through education and participation. 3. Within the framework of a collaborative practice model, the patient, clinical nurse specialist, and psychiatrist share equal power and responsibility. A phenomenologically oriented approach whereby the health-care provider attempts to understand the patient's illness from the patient's perspective is a crucial component. 4. The Medication Program combines the expertise of nursing and medicine in a complementary fashion, conducive to both revenue-generating activity and cost-effective role use.

T cell receptor expression in Sjögren's syndrome

T lymphocytes expressing the gamma/delta T cell receptor and B lymphocytes expressing CD5 are known to occur in expanded numbers in the peripheral blood of patients with primary Sjögren's syndrome. The cellular infiltrates for the surface phenotypic markers for alpha/beta and gamma/delta T cell receptors, CD4, CD8, CD45, and CD5 were examined in lip biopsy specimens from two patients with primary Sjögren's syndrome, six with secondary Sjögren's syndrome, and seven healthy controls. Most of the Sjögren's lip biopsy cellular infiltrates were T lymphocytes of the CD4 subset expressing the alpha/beta T cell receptor (mean 70%). The low prevalence of gamma/delta T cell receptor bearing cells in lip biopsy specimens is maintained in Sjögren's syndrome (mean 1.5%), and thus it seems unlikely that these lymphocytes bearing the gamma/delta T cell receptor have a major role in the immunopathology of Sjögren's syndrome. Over 70% of cells within the lesional infiltrate of primary and secondary Sjögren's syndrome expressed the CD5 and CD45 cell surface molecules.

Immunohistochemical assessment of ER-P31, a mouse anti-oestrogen receptor protein monoclonal antibody in human breast cancers: comparison with ER-ICA (Abbott) and radioligand assays

A new mouse anti-oestrogen receptor (ER) monoclonal antibody, ER-P31, has been developed. Comparisons of immunohistochemical detection of ER in human breast cancers using ER-P31 with anti-ER from ER-immunocytochemical assay (ER-ICA; Abbott Diagnostic Division) and radioligand dextran-coated charcoal (DCC) assays were carried out. A total of 63 breast cancers, both ER-negative and -positive, were tested. A highly significant degree of correlation between immunostaining for ER-P31 and both ER-ICA and DCC assays was obtained. It is hoped that once ER-P31 is widely available commercially, determination of ER status in breast cancers should be routinely and economically available to all women with breast cancer. Moreover, with the introduction and implementation of a screening programme for detecting breast cancers, immunocytochemical determination of ER status in unequivocal and equivocal positive fine-needle aspirates of breast lesions can be readily performed.

Comparison of elemental concentrations in the acinar cells of the human labial salivary gland

Two types of acinar cells were observed in human labial glands by conventional and analytical electron microscopic and light microscopic techniques. The predominant type contained large and prominent secretory granules that were strongly mucicarmine and PAS (with and without diastase) positive. The second type contained small, lacy, secretory granules, and these cells were faintly positive with these stains. The elemental contents of the two types of granules were measured by analytical electron microscopy using digital mapping and spot analysis applied to freeze-dried cryosections prepared from gland slices incubated in vitro under non-stimulated conditions. The large secretory granules had significantly higher Ca, S and Mg concentrations and significantly lower Cl and K concentrations than the small granules. The difference in elemental contents probably reflects differences in the content of secretory macromolecules. Specifically, the S content is thought to reflect the anionic properties of the secretory macromolecules, while the levels of divalent cations are thought to be determined by electroneutrality requirements for macromolecular folding and storage. No differences were found in nuclear or cytoplasmic elemental concentrations between the two cell types.

Concentrations of temafloxacin in serum and bronchial mucosa

The bronchial mucosal concentrations of temafloxacin hydrochloride were determined in specimens obtained at fibreoptic bronchoscopy and compared with simultaneous serum concentrations. The 18 patients studied were given an oral dose of 400 mg b.i.d for three days to achieve steady state levels. The mean serum concentration was 6.9 mg/l (SD 2.5 mg/l) and the mean bronchial mucosal concentration 12.2 mg/kg (SD 4 mg/kg). The mucosal levels exceeded those required to inhibit most of the common respiratory pathogens, including Streptococcus pneumoniae and Pseudomonas aeruginosa. These data support the use of temafloxacin for therapy of bronchial infections.

NCL-CB11, a new monoclonal antibody recognizing the internal domain of the c-erbB-2 oncogene protein effective for use on formalin-fixed, paraffin-embedded tissue

The c-erbB-2 proto-oncogene encodes a 190 k Mr protein representing a putative growth factor receptor with considerable homology to the EGF receptor. Gene amplification and overexpression of the oncogene protein have been demonstrated in a variety of tumours including breast cancer, where it is associated with a poor prognosis. In this study we have produced and characterized a mouse monoclonal antibody, designated NCL-CB11, to the c-erbB-2 protein. NCL-CB11 was generated to a synthetic peptide sequence corresponding to a site of predicted antigenicity near the C-terminus of the internal domain of the protein. NCL-CB11 produces intense membrane-associated immunohistochemical staining in a proportion of human cancer cells. The specificity of the antibody is supported by Western blotting and immunoprecipitation studies. Reactivity with an internal site of the protein is confirmed by the necessity of cell permeabilization for reactivity in fluorescence-activated cell sorter (FACS) analysis. A high degree of correlation between immunohistochemical staining using NCL-CB11, and c-erbB-2 gene amplification has been observed. NCL-CB11 should prove to be a valuable reagent for investigations into the pathological significance of c-erbB-2 protein expression.

Care and management of twins

This is a study of the maternal care of 84 sets of twins in their own homes in Sheffield, compared with random and matched singleton controls funded by the Foundation for the Study of Infant Deaths. The findings suggest that the stress experienced by parents appears to be related more to the number of children to be cared for than the fact of twinning. The study revealed that twin babies received more health visitor care and less GP care than singleton babies.

A central 6-hydroxydopamine lesion prevents fluphenazine-induced increase in plasma homovanillic acid

Plasma and brain levels of the dopamine metabolite, homovanillic acid, were measured in rats after acute and chronic treatment with fluphenazine. After acute administration, homovanillic acid levels were increased in the whole frontal cortex, caudate nucleus, nucleus accumbens, anterior cingulate (supragenual) cortex, prefrontal cortex and plasma. Following chronic administration, the effects of single doses of fluphenazine in increasing homovanillic acid were markedly attenuated in the caudate nucleus, nucleus accumbens, the whole frontal cortex, anterior cigulate cortex and plasma, but not in the prefrontal (anteromedial) cortex. Following fluphenazine administration plasma homovanillic acid levels were correlated with homovanillic acid concentrations in whole frontal cortex (r = 0.63, p less than 0.01) and caudate nucleus (r = 0.51, p less than 0.05). Further, prior intracerebroventricular administration of 6-hydroxydopamine prevented the fluphenazine-induced increase in plasma homovanillic acid. These data suggest that in the rat, plasma and brain (caudate nucleus and whole frontal cortex) homovanillic acid levels change in a similar fashion during acute and chronic neuroleptic administration.

Cytokeratins in cervical dysplasia and neoplasia: a comparative study of immunohistochemical staining using monoclonal antibodies NCL-5D3, CAM 5.2, and PKK1

The expression of low molecular weight cytokeratins (normally expressed only in simple epithelia) in intraepithelial neoplasia of grade CIN III or greater in cervical biopsies has recently been described by Bobrow et al. Our study of 127 cases confirms this finding and in addition we compare the use of three monoclonal antibodies, namely NCL-5D3, CAM 5.2, and PKK1, in demonstrating the phenomenon. Both NCL-5D3 and CAM 5.2 give consistently negative results for non-neoplastic stratified squamous epithelium, as well as CIN I and CIN II lesions, whilst staining about 30 per cent of CIN III biopsies and most carcinomas. PKK1, on the other hand, stained 50 per cent of non-neoplastic epithelia and thus did not serve as a marker of severe dysplasia. The possible implications of these observations are discussed.

Ultrastructural abnormalities of epididymal tissues in XXSxr pseudomale (sex-reversed) mice

Sex reversed (Sxr), a duplication of the Y chromosomal testis-determining factor in mice, causes testis development in XXSxr animals. No effects of Sxr on nongonadal organs are expected. However, we have previously shown that the epididymis of XXSxr pseudomale (sex-reversed) mice lacks the Initial Segment. In the present study we examined the ultrastructure of the head of the epididymis of adult and 21-day old XXSxr pseudomale mice. Epithelial cells of both adult and juvenile XXSxr animals contain numerous vesicles, some within mitochondria. The basal lamina is thickened and infolded. The periepithelial layer is abnormally thick, with distorted smooth muscle cells and fibrocytes that also contain lysosomelike vesicles, often in mitochondria, and excessively wide intercellular spaces. Normal collagen fibrils are infrequent; they are in part replaced by wisps of nondiscrete material, possibly immature collagen. Sxr is known to affect spermatogenesis and Sertoli cells. The abnormal conjugation of sex-determining genes in XXSxr appears also to subvert mesenchymal-epithelial development in both epididymis and testis. We believe the most likely explanation of our data is that the XXSxr genotype is not testis specific but also influences the epididymis directly.

Narcissism and social interest among counselors-in-training

The anticipated negative correlation between social interest and narcissism among 78 counselor trainees was −.28. This provides evidence for regarding narcissism as a dimension of personality.

Valva ileocaecalis: preservation during ileocolonic surgery employing a rodent experimental model

Experimental and clinical data suggest that the valva ileocaecalis under neurogenic and hormonal influences, modulates antegrade and retrograde flow of succus entericus. A priori reasoning suggests that this function may influence nutrient absorption by and intraluminal endogenous microbial flora within the ileum. The hypothesis to be tested was, can anatomical and functional integrity of the valva ileocaecalis be preserved during the performance of a right hemicolectomy with reestablishment of intestinal continuity via a cecocolostomy? The methodology involved utilization of Lewis male rats weighing approximately 500 gm. General anesthesia was induced for all procedures. The animals were randomly assigned to three groups (10 animals/group): (A) sham operation; (B) pericecal dissection (preservation of the arteria et vena ileocolica); and (C) periileal dissection (ligation of the aforementioned vessels). Celiotomy was performed employing standard clean techniques, and was accompanied by a right hemicolectomy and an end-to-end or end-to-side cecocolostomy. Function of the heterotopic valva ileocaecalis was assessed 6-12 weeks post-operatively employing radiographic criteria (fluoroscopic analysis after intraluminal instillation of barium sulfate). Light microscopic analysis was performed subsequent to the radiographic studies. Periileal dissection associated with ligation of the arteria et vena ileocolica uniformly resulted in anastomotic disruption. Pericecal dissection associated with preservation of those vessels resulted in uniform anastomotic integrity, although two animals succumbed secondary to pneumonitis within 5 post-operative days. Radiographic analysis of the heterotopic valva ileocaecalis revealed intermittent antegrade and no retrograde flow of contrast material, which suggested functional integrity. Qualitative light microscopic analysis revealed architectural integrity.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic corticosterone administration in rats: behavioral and biochemical evidence of increased central dopaminergic activity

Chronic corticosteroid treatment in humans in frequently complicated by behavioral changes. The present study suggests that chronic steroid administration in rats has distinct neurochemical consequences which are behaviorally relevant. Ten male Sprague-Dawley rats received 7 daily injections of corticosterone, following which they exhibited increased caudate homovanillic acid as well as an attenuated decline in vertical and ambulatory movement (functional measures of dopamine activity) compared to placebo-treated rats. A subgroup of steroid-treated rats which was more behaviorally responsive to corticosterone also showed increased caudate 5-hydroxyindole acetic acid and decreased prefrontal cortex dopamine and serotonin. These results are discussed in relation to the known behavioral side effects of chronic corticosteroid administration in man and the psychiatric manifestations of naturally occurring states of hypercortisolemia.