Diastasis of bipartite sesamoids of the first metatarsophalangeal joint

Injury to the metatarsophalangeal (MP) joint of the great toe, often termed "turf-toe", is a common occurrence in football. We have identified four cases of first MP plantar capsular injury with diastasis of a bipartite sesamoid. In three cases, observation and protection resulted in progressive widening of the fragments associated with pain and disability. These players required resection of the distal sesamoid fragment and repair of the volar capsule. The fourth player underwent acute repair of the medial retinaculum and capsule. All players have had a full return to sports activity. Diastasis of components of a partite sesamoid provides objective evidence of disruption of the plantar capsular mechanism. Early recognition of this condition confirmed by stress radiographs is recommended. Treatment may include early protection followed by resection, if painful, or acute repair of the retinaculum. Previous descriptions of turf-toe have not included injuries to the sesamoid complex of the first MP joint. In our opinion, the term turf-toe should represent the consequences of a hyperextension injury to the first MP joint in which the volar capsule has been disrupted proximal to the sesamoid. A classification for first MP joint injuries is presented.

Microsatellite polymorphism linkage map of human chromosome 13q

Twelve polymorphic (CA)n microsatellites were isolated from a flow-sorted chromosome 13 genomic library. These, and two others that have been previously described, were genotyped in 41 families from the CEPH (Centre d'Etude Polymorphisme Humain, Paris), and a primary linkage map with considerable support for order (odds > 10,000:1) was constructed. Two RFLP-based markers, COL4A1 and D13S52, with heterozygosities above 0.67 and an RFLP-based centromeric marker at D13Z1 were included in this map which extends from 13cen to 13q34. The heterozygosity of all of the PCR-based markers is above 60%. The total map spans a genetic distance of 144 cM, extending from D13Z1 to D13S52 with a single maximum intermarker recombination distance of 35 cM. All other intermarker recombination distances are 18 cM or less. Marker order was confirmed by sublocalizing many of the microsatellite containing clones on a panel of rodent-human somatic cell hybrids with deletions and rearrangements of chromosome 13. One spontaneous new mutation for these 14 (CA)n repeat markers was identified from a total of 8006 gametes, giving an overall observed spontaneous mutation rate of 0.00012 per locus per gamete. An integrated map of chromosome 13q was constructed with the microsatellite markers described here and previously genotyped RFLP-based markers. This sex-average map spans 209 cM with an average distance between unique map locations of 4.5 cM; the maximum intermarker distance was 14 cM.

A pilot study of pi-class glutathione S-transferase expression in breast cancer: correlation with estrogen receptor expression and prognosis in node-negative breast cancer

PURPOSE AND METHODS

Previous studies have indicated that RNA levels for pi-class glutathione S-transferase (GST pi), a phase II, drug-metabolizing enzyme, were inversely related to estrogen receptor (ER) and progesterone receptor (PR) levels in human breast tumors. Because GST pi also is expressed in normal breast epithelium, an immunohistochemical assay that uses affinity-purified polyclonal antibodies to GST pi was developed to examine the possible relationship between GST pi expression in breast cancer cells and hormone receptor expression, as well as prognosis, in patients with primary breast cancer.

RESULTS

A strong inverse correlation between GST pi expression and ER (two-sided P [P2] = .002) and PR status (P2 = .023) was found in our study of 189 patients with primary breast cancer. GST pi expression was not related to tumor size, nodal metastasis, nuclear grade, histology, or age of the patient. In node-negative breast cancer (n = 72), increased GST pi expression was associated with decreased disease-free survival (DFS) and overall survival (OS). When GST pi expression was divided into categories of negative (no GST pi-positive tumor cells), intermediate (1% to 70% GST pi-positive tumor cells), and high (> 70% GST pi-positive tumor cells), the relative risk of tumor recurrence in patients with node-negative breast cancer was increased 3.39-fold for each successive category of expression (P2 = .0045; 95% confidence interval, 1.46 to 7.87) and the relative risk of death was increased 4.49-fold for each successive category (P2 = .0003; 95% confidence interval, 2.02 to 10.42). The actuarial 5-year OS was 100%, 79%, and 51%, and the DFS was 94%, 77%, and 44%, for the negative, intermediate, and high tumor groups, respectively. Among the factors studied in multivariate analysis (ER status, PR status, nuclear grade, and tumor size), GST pi expression was the factor that most accurately predicted shorter DFS and OS in node-negative patients.

CONCLUSION

GST pi expression is inversely related to hormone receptor status in breast cancer. This pilot study also suggests that increased GST pi expression may be an important predictor of early recurrence and death in node-negative breast cancer patients that merits additional investigation.

Increased risk for polycystic ovary syndrome associated with human leukocyte antigen DQA1*0501

OBJECTIVE

The objective of this investigation was to identify genes that confer susceptibility to polycystic ovary syndrome.

STUDY DESIGN

Nineteen subjects with polycystic ovary syndrome, hirsutism, and elevated plasma androgen levels and 46 fertile, female control subjects were studied. Alleles at the human leukocyte antigen DQA1 locus were identified with dot-blot hybridizations with allele-specific oligonucleotide probes. Associations between human leukocyte antigen DQA1 alleles and polycystic ovary syndrome were examined with logistic regression analysis.

RESULTS

The frequency of the human leukocyte antigen DQA1*0501 was 0.50 and 0.26 in subjects with polycystic ovary syndrome and control subjects, respectively (corrected for multiple comparisons, p = 0.067). Homozygosity for this allele was also increased among subjects with polycystic ovary syndrome (p = 0.054). The odds ratios for having polycystic ovary syndrome associated with the *0501 allele and the *0501/*0501 homozygous genotype were 2.8 and 5.8, respectively.

CONCLUSION

These data suggest that a polycystic ovary syndrome susceptibility allele is linked to human leukocyte antigen and that the susceptibility allele is recessive.

Association of coagulation factors and inhibitors with carotid artery atherosclerosis. Early results of the Atherosclerosis Risk in Communities (ARIC) Study

Several population studies have shown that plasma levels of fibrinogen and factor VII are significantly associated with ischemic cardiovascular events. However, there is little information regarding the association of hemostatic factors with early atherosclerosis. To evaluate this, we compared the plasma concentrations of several coagulation proteins (fibrinogen, factor VII, factor VIII, von Willebrand factor, protein C, and antithrombin III) between 385 case patients, defined by high-resolution B-mode ultrasonography as having carotid arterial wall thickening, and 385 age-, race-, and sex-matched control subjects. These case patients and control subjects were selected from participants in a prospective population investigation, the Atherosclerosis Risk in Communities (ARIC) Study, who were examined between May 1987 and May 1989. Plasma fibrinogen, factor VII, protein C, and antithrombin III levels were significantly higher in case patients than in control subjects (P < 0.05). Factor VIII and von Willebrand factor were not different. These findings were supported by quartile distribution and univariate analysis. However, only fibrinogen remained significantly associated with carotid atherosclerosis on multivariate analysis taking other atherosclerosis risk factors into consideration. A one standard deviation increase in fibrinogen (67 mg/dL) was associated with a 1.6-fold increase in the odds of carotid atherosclerosis univariately (P < 0.001) and with a 1.3-fold increase in the odds multivariately (P = 0.010). Further analysis revealed that the association of fibrinogen with carotid atherosclerosis was somewhat stronger in cigarette smokers than in nonsmokers. This early case-control analysis of the ARIC Study demonstrates a significant association between plasma fibrinogen concentration and early atherosclerosis in the carotid arteries. In the context of published findings from population studies, our results indicate that plasma fibrinogen concentrations may be a useful marker for identifying individuals at high risk of developing arterial thrombotic disorders.

Drug use and suicide ideation and behavior among North Carolina public school students

We used data from 3064 respondents to the 1990 North Carolina Youth Risk Behavior Survey to examine the relationship between adolescent drug use and suicide ideation and behavior. Principal components analysis followed by varimax rotation was performed separately on the drug use and suicide items. Correlation coefficients computed between the two sets of factor scores and comparison of mean drug use factor scores revealed that drug use, particularly of crack/cocaine, was related to increased suicide ideation and behavior.

Imipramine in the treatment of depressed Alzheimer's patients: impact on cognition

A double-blind study evaluated the impact of imipramine on cognitive function in 61 patients with Alzheimer's disease. Twenty-eight patients had coexistent depression and dementia; 33 had dementia only. All were randomly assigned to an 8-week trial of imipramine or placebo. For both depressed and nondepressed subjects, the effect of imipramine on cognition was minimal. A subtle decrement in general cognitive function was evident in those treated with imipramine, as compared with those treated with placebo. No effects were observed on memory. Clinicians are advised that very low doses of imipramine (25 mg/daily) may be tolerated in depressed Alzheimer patients, but that cognitive changes do occur in some patients and should be carefully monitored.

Transvaginal intratubal insemination by tactile sensation: a preliminary report

Transvaginal catheterization of the fallopian tube has gained increased popularity for transfer of embryos and gametes. Forty-five ITIs were performed on 32 patients using the novel approach of tubal transfer via tactile sensation. This group of patients had undergone an average of 5.2 IUIs before ITI. There were a total of 11 pregnancies, 6 occurring with hMG stimulation and 5 with CC-stimulated cycles (34% PR per patient). Three pregnancies ended with spontaneous abortion, and one patient developed acute salpingitis necessitating laparotomy. These data suggest ITI may be effective in assisted reproduction but, as other invasive procedures, is not without risk.

Low nm23 protein expression in infiltrating ductal breast carcinomas correlates with reduced patient survival

Protein levels corresponding to nm23 were determined in normal and neoplastic breast tissues by immunoperoxidase staining. Nm23 protein levels were highest in normal breast epithelium, and lower in intraductal carcinomas. Based on nm23 staining, 39 infiltrating ductal carcinomas were separated into two groups: tumors with homogeneously high nm23 protein content, and tumors with low staining in either a homogeneous or heterogeneous pattern. Patients with low nm23 staining tumors, determined by three pathologists independently, had reduced survival times (alpha = 0.034, alpha = 0.012, alpha = 0.052 by the log rank test). Nm23 expression approached significance as an independent predictor of survival in Cox's proportional hazards model. The data provide the first correlation of low nm23 protein expression and reduced breast carcinoma patient survival.

Carotid atherosclerosis measured by B-mode ultrasound in populations: associations with cardiovascular risk factors in the ARIC study

To assess whether carotid atherosclerosis measured by B-mode ultrasound is related to cardiovascular risk factors, 386 cases with carotid artery wall thickening and an equal number of controls free of arterial intima-media thickening were drawn from the cohort of the Atherosclerosis Risk in Communities (ARIC) Study examined in four communities in the United States between 1988 and 1990. Cases and controls were individually matched on sex, race, age group, study center, and date of examination. The mean values of total cholesterol, low density lipoprotein (LDL) cholesterol, total triglyceride, blood pressure, and pack-years of cigarette smoking were higher in cases than controls. Mean high density lipoprotein (HDL) cholesterol was lower in cases than controls. Case-control differences were all statistically significant. Multivariable-adjusted odds ratios point to differences of considerable magnitude in the risk of carotid atherosclerosis between groups defined by clinical and public health-oriented risk factor cut-points.

Potential value of hormone receptor assay in carcinoma in situ of breast

The estrogen receptor (ER) expression of invasive breast cancer has been extensively studied both biochemically and with specific monoclonal antibodies against ER. Relatively few studies have attempted to characterize ER pattern in breast carcinoma in situ (CIS) and in other premalignant lesions. In the current study, the authors investigated the pattern of ER expression in 62 cases of breast CIS, 30 of which had a component of invasive cancer, and 36 cases of atypical hyperplasia. Paraffin sections of formalin-fixed breast tissue underwent enzyme pretreatment to expose nuclear antigenic sites as previously described. Breast tissues then underwent estrogen immunocytochemical assay using specific monoclonal antibodies (Abbott Laboratory, Chicago, IL). The cases were evaluated for heterogeneity, intensity of staining, and percentage of ER-positive cells. An attempt was made to study the relation between the pattern of ER expression, nuclear pleomorphism, and type of CIS. The results of ER immunocytochemical assay showed positive nuclear staining for ER in 75% of the CIS, 73% of CIS with invasive cancer, and 100% of atypical hyperplasias. ER expression in CIS agreed with that in the invasive carcinoma in 29 of 30 cases. This study also suggests that comedocarcinoma has a higher incidence of negative ER expression than the other types of CIS, particularly when it is associated with significant nuclear pleomorphism. There was no significant difference in ER tumor heterogeneity between premalignant and malignant lesions.

Extragenital granuloma inguinale mimicking a soft-tissue neoplasm: a case report and review of the literature

Granuloma inguinale has been reported to mimic squamous cell carcinoma, as well as sexually transmitted diseases. We describe a rare case of extragenital granuloma inguinale that mimicked a soft tissue neoplasm in an 18-year-old pregnant woman who presented with cervical and labial ulcers. An elective cesarean section was performed, at which time a retroperitoneal mass that involved the right ureter was found. At frozen section, the mass had a xanthogranulomatous appearance consistent with a soft-tissue neoplasm. Special stains of the permanent sections revealed the pathognomic features of granuloma inguinale.

Turf-toe: an analysis of metatarsophalangeal joint sprains in professional football players

Metatarsophalangeal joint injuries of the great toe (turf-toe) are receiving increasing attention in the literature because of the prevalence of synthetic surfaces and lighter, more flexible shoes. Eighty active professional football players were evaluated. The mechanism of injury was hyperextension in 85% of the players. Eighty-three percent reported their initial injury on artificial turf (P less than 0.05). Other factors significantly related to the incidence of turf-toe included player age (P less than 0.01), number of years in professional football (P less than 0.01), and range of ankle dorsiflexion (P less than 0.05). Turf-toe injury resulted in significantly decreased range of motion of the first metatarsophalangeal joint (P less than 0.01).

Interpractice visits by general practitioners: implications of a pilot project for quality assurance in general practice

This article describes a pilot study involving 25 general practitioners who agreed to undertake interpractice visits. Decisions regarding the nature, length and documentation of the interpractice visit were made by consensus during a 5-h workshop. Participants met again as a group after the visits were completed and discussed the acceptability of the visits and their potential to improve standards of care. Reactions included a high level of enthusiasm to develop further the rigour of these visits.

Isolated trout liver cells: establishing short-term primary cultures exhibiting cell-to-cell interactions

Composition and interactions of cell types in rainbow trout (Oncorhynchus mykiss) liver digested with collagenase and cultured in serum-free media were investigated. Suspensions obtained after digesting trout liver with collagenase contained all the cell types present in the liver, including liver parenchymal cells (hepatocytes), biliary epithelial cells, sinusoidal endothelium, fat-storing cells of Ito, and macrophages. A major cell pellet, mainly hepatocytes but containing significant numbers of biliary epithelial cells, was obtained by centrifuging the cell suspension at 120 X g for 1 min. Cells present in this pellet quantitatively attached to culture plates coated with a trout skin extract and remain attached for 4 to 6 d with good retention of intracellular enzymes and DNA. When in culture, significant changes in and among the cells were observed. Initial preparations were rounded, single cells. Within several hours, however, cellular interactions leading to aggregation became evident and aggregates increased in size for 2 to 3 d. Scanning electron microscopy (EM) showed frequent shaftlike projections from margins of the aggregates. Transmission EM indicated that these projections represent biliary ductules forming in vitro. Adjacent hepatocytes also showed plasma membrane specializations forming junctional complexes and canaliculi characteristics of normal trout liver. After 5 to 6 d in culture, significant numbers of the cell aggregates dislodged from the plate. Analysis showed the dislodged cells were viable but vacuolated. The reestablishment in vitro of morphologic relationships resembling in situ tissue components suggest these culture preparations may have significant utility in cooperative metabolic studies of cell interactions in trout liver.

Lymphogranuloma venereum: 27 cases in Paris

Twenty-seven men with laboratory-confirmed lymphogranuloma venereum (LGV) were identified among 211 patients tested for LGV or chancroid during a 6-y period. The patients with LGV ranged in age from 17 to 73 y; most were from countries other than France. Twenty-five sought care because of inguinal adenopathy (with spontaneous draining fistulae in two patients) and two because of proctitis. Chlamydia trachomatis was isolated from nine patients; all isolates were the LGV biovar as demonstrated by biologic characterization and monoclonal antibody reactivity. In patients without isolation of C. trachomatis, the diagnosis was based on chlamydial complement fixation antibody titers greater than or equal to 1:32 (mean titer, 1:128). Genital herpes was an associated diagnosis in one patient and syphilis in two patients. Serologic evidence of exposure to human immunodeficiency virus (HIV) type 1 was present in five patients and to HIV-2 in one patient.

How much soil do young children ingest: an epidemiologic study

Sixty-four children aged 1-4 years were evaluated for the extent to which they ingest soil. The study followed the soil tracer methodology of S. Binder, D. Sokal, and D. Maughan (1986, Arch. Environ. Health, 41, 341-345). However, the present study included a number of modifications from the Binder et al. study. The principal new features were (1) increasing the tracer elements from three to eight; (2) using a mass-balance approach so that the contribution of food and medicine ingestion would be considered; (3) extending the period of observation from 3 days to 8 days; and (4) validating the methodology by having adult volunteers ingest known amounts of soil in a mass-balance validation study. The principal findings reveal the following. (1) The adult study confirmed the validity of the tracer methodology to estimate soil ingestion. (2) Of the eight tracers employed in the adult study, only Al, Si, and Y provided sufficient recovery data that was directly acceptably stable and reliable. (3) If food ingestion determinations were taken into consideration, the median estimates of soil ingestion from the eight tracers ranged from a low of 9 mg/day (Y) to a high of 96 mg/day (V); the median values of Al, Si, and Y, the three most reliable tracers, ranged from 9 mg/day to 40 mg/day. (4) One child had soil ingestion values ranging from 5 to 8 g/day, depending on the tracer. (5) If food ingestion had not been considered, the estimates of soil ingestion would have increased about two- to sixfold, depending on the tracer with Ti and Y being most affected by food intake. (6) Since soil and dust samples did not significantly differ in their levels of tracer elements, no reliable differentiation between the contribution of ingestion of dust and soil could be made. (7) These findings are generally consistent with the previously reported findings of Binder et al. (1986) and P. Clausing, B. Brunekreff, and J.H. van Wijnen (1987, Int. Arch. Occup. Med., 59, 73) if these latter studies are corrected for ingestion of tracers in food and medicine. The findings also account for the apparent discrepancy between the estimates from Al and Si and estimates based on Ti in previous studies. Thus the elevated estimates of soil ingestion by Ti were substantially reduced when food ingestion is considered.

Evaluation of the 7-h membrane filter test for quantitation of fecal coliforms in water

The 7-h fecal coliform (FC) test for detection of FC organisms in water was evaluated to establish its validity and usefulness for emergency and disaster situations. The waters tested consisted of routine samples collected for public health surveillance and enforcement purposes. A total of 984 water samples from throughout California were assayed. These included samples from coastal salt waters, rivers, canals, and reservoirs, in addition to potable and miscellaneous freshwater sources. A portion of each sample was tested concurrently by both the 7-h FC test and the most-probable-number FC five-tube test. The 7-h FC test samples were incubated for 7 to 7.25 h at 41.5 degrees C. Overall, greater than 90% agreement was obtained between the methods in determining whether the water quality was acceptable or unacceptable. Statistical analysis of the 984 samples confirmed that the 7-h FC method was a suitable alternative to the most-probable-number FC method for evaluation of freshwater samples. During emergencies or disasters, the 7-h FC test could provide a means for detection of fecal contamination of water with results available in less than 1 day.

Screening for large bowel cancer

Is there a need for yet another screening process to be applied in general practice with all the consequent costs in terms of materials, doctors' time and patient anxieties? What is the evidence for and against screening for colorectal cancer?

Turf Toe: Diagnosis and Treatment

In brief: The prevalence of artificial playing surfaces on football fields and the use of lightweight shoes on these surfaces have been associated with an increased incidence of metatarsophalangeal joint sprains of the great toe, a condition commonly known as turf toe. Artificial turf tends to decrease shock absorption, and lightweight shoes do not give the player adequate support. Signs and symptoms include pain, hyperemia, and swelling around the joint. Roentgenograms show only generalized soft-tissue swelling unless there is a concomitant fracture. The authors review the pertinent anatomy, mechanisms of injury, differential diagnosis, and possible long-term sequelae of turf toe. In addition, they present guidelines for treatment, return to activity, and prevention.

The polycystic ovary syndrome: pathogenesis and treatment

PURPOSE

To propose a theory for the pathogenesis of the polycystic ovary syndrome that explains the endocrinologic abnormalities of the syndrome and provides a rational approach to therapy.

DATA IDENTIFICATION

An English-language literature search using MEDLINE (1975 to 1988) and extensive bibliographic reviews of identified articles.

STUDY SELECTION

We reviewed the literature and selected 169 articles considered most relevant for the definition of the endocrinologic abnormalities, elucidation of pathogenic mechanisms, or delineation of therapeutic interventions.

DATA EXTRACTION

The authors independently assessed study quality and data concerning endocrinologic abnormalities, pathogenic mechanisms, and therapy of the polycystic ovary syndrome.

RESULTS OF DATA SYNTHESIS

The polycystic ovary syndrome may be best defined as functional, gonadotropin-dependent ovarian hyperandrogenism. The polycystic ovary syndrome results when a primary defect increases one of three variables: the ratio of the serum concentrations of luteinizing hormone to follicle stimulating hormone, the ratio of the intraovarian concentrations of androgen to estrogen, or follicular atresia. An increase in one of these variables can then induce successive abnormalities in one or more of the remaining two variables in a to-and-fro manner.

CONCLUSIONS

Evidence suggests that several causes exist, each of which can produce the clinical syndrome by a to-and-fro interaction among pathogenic mechanisms. Treatment objectives for the syndrome include amelioration of hirsutism, induction of ovulation, and weight reduction.

Double-blind trial of imipramine in Alzheimer's disease patients with and without depression

The authors divided 61 subjects with primary degenerative dementia of the Alzheimer's type into a group who also met DSM-III criteria for depression (N = 28) and a group who did not (N = 33). Both groups were randomly assigned to an 8-week double-blind trial of imipramine or placebo. Scores on the Hamilton Rating Scale for Depression, administered at baseline and weeks 2, 4, 6, and 8, indicated significant improvement in both groups. Two measures of cognitive function yielded differing results. The results suggest that moderate depression is a treatable condition in patients with Alzheimer's disease.

Space Station atmospheric monitoring systems

A technology assessment study on atmospheric monitoring systems was performed by Battelle Columbus Division for the National Aeronautics and Space Administration's John F. Kennedy Space Center under Contract No. NAS 10-11033. In this assessment, the objective was to identify, analyze, and recommend systems to sample and measure Space Station atmospheric contaminants and identify where additional research and technology advancements were required. To achieve this objective, it was necessary to define atmospheric monitoring requirements and to assess the state of the art and advanced technology and systems for technical and operational compatibility with monitoring goals. Three technical tasks were defined to support these needs: Definition of Monitoring Requirements, Assessment of Sampling and Analytical Technology, and Technology Screening and Recommendations. Based on the analysis, the principal candidates recommended for development at the Space Station's initial operational capability were: (1) long-path Fourier transform infrared for rapid detection of high-risk contamination incidences, and (2) gas chromatography/mass spectrometry utilizing mass selective detection (or ion-trap) technologies for detailed monitoring of extended crew exposure to low level (ppbv) contamination. The development of a gas chromatography/mass spectrometry/matrix isolation-Fourier transform infrared system was recommended as part of the long range program of upgrading Space Station trace-contaminant monitoring needs.

Seminoma of the testis at Groote Schuur Hospital, 1973-1984

The clinical records of 47 patients with testicular seminoma treated between 1973 and 1984 were reviewed. The mean age was 41 years. There were relatively few blacks and patients of mixed race--4% and 17% respectively. The incidence of associated testicular maldescent was statistically significantly higher among the black and mixed-race patients (40%) than among the white patients (8%). Forty-three patients underwent retroperitoneal irradiation after orchidectomy, with a 5-year survival rate of 87% at a median follow-up of 52 months. There were no relapses at follow-up in 27 stage I patients; 1 of 8 patients with stage IIA and B (non-bulky) disease relapsed after 12 years, and relapses occurred in all 5 patients with stage IIC (bulky) seminoma. Retroperitoneal and mediastinal irradiation has controlled disease in 2 patients with stage III disease without bulky metastases. One patient with stage IV seminoma treated with irradiation relapsed. One of the patients with stage I disease has developed a major bowel complication following 3,000 cGy fractionated irradiation. Our experience with cis-platinum-based chemotherapy includes noting its effectiveness in a patient with unresectable locally advanced testicular seminoma. We recommend retroperitoneal irradiation after orchidectomy for patients with stage I and IIA/B disease and cis-platinum combination chemotherapy after orchidectomy for those with more advanced disease.

Evaluation of a new dressing in the treatment of sports-related skin lesions

Twenty-seven players with superficial wounds (abrasions, turf burns, and blisters) were treated with a new Hydroactive dressing. We conclude that this dressing provides an excellent alternative to other forms of treatment since it is easy to use, comfortable, hypoallergenic, and provides impressive healing results.

An outbreak of hepatitis B and D in butchers

This report documents an outbreak of hepatitis B (HB) and hepatitis D (HD) in a group of butcher shop employees. During the 13-month period from September 1983 to October 1984, 8 employees from 2 establishments developed acute HB. Epidemiological investigation suggested that the first case, who was also an intravenous drug user, was the source of infection for other employees. This person and 2 others were found to have concurrent HD. In November 1984 the wife of one of the infected butchers also developed HB.

Busulphan and cyclophosphamide cause little early toxicity during displacement bone marrow transplantation in fifty children

Fifty children were induced with busulphan and cyclophosphamide before bone marrow transplantation. Our standard dose of cyclophosphamide was 2 g/m2 daily for 4 days, but this dosage was reduced if necessary so as not to exceed 75 mg/kg/day. A basal pulse rate that increased by more than 20 beats/min or a reduction in ECG voltage were indications for stopping cyclophosphamide. As a consequence, the fourth dose of cyclophosphamide was omitted for four children. One child died of cardiac arrest related to cyclophosphamide. We used busulphan at a dosage of 4 mg/kg/day for 4 days; neither 'busulphan lung' nor veno-occlusive disease occurred in any patient. The use of busulphan and cyclophosphamide did not guarantee freedom from interstitial pneumonitis, but this seemed to be related rather to the nature of prior treatment and the cytomegalovirus antibody status of the patient. Thus, we have developed a safe chemotherapy schedule for transplantation that avoids the need for radiotherapy and can, if necessary, be repeated after a 3-month interval.

Use of registers and population censuses as sampling frames in Great Britain

The use of official data sources as sampling frames for numerous government surveys in the United Kingdom is described. "The great majority of these surveys use registers of various kinds as sampling frames. Some of these registers are intended to cover all addresses in the country in which there are private households. Other registers relate to specific sub-groups of the population. Each of the general registers has advantages and disadvantages but none is ideal for sampling purposes. In recent years nearly all samples required of the general population have been drawn, by automated means, from the Postcode Address File, although the balance of advantages of this system need to be continually monitored and evaluated." Reasons why the census is not often used as a sampling frame are considered.

Pharmacologic treatment of agitation associated with dementia

Pharmacotherapy of aggressive or agitated behaviors in the dementia patient has not been studied extensively, despite the prevalence of this problem. Neuroleptics have the most support for efficacy, with shorter acting benzodiazepines demonstrating benefit on occasion. However, studies done to date indicate that these drugs are effective only for a minority of patients and that side effects frequently make patients worse. Other medications, such as propranolol, carbamazepine, or lithium, may be helpful, but their efficacy in dementia patients has not been demonstrated in placebo-controlled studies. Until such studies are done, their use is most appropriate in special patient groups or in patients who have failed neuroleptic or benzodiazepine treatment. More studies are needed in elderly patients evaluating effectiveness of pharmacologic agents in specific types of dementia, particularly Alzheimer's disease. Most studies done to date have been of relatively short duration, usually two months or less. Because these medications often are given to dementia patients for prolonged periods, studies are needed to define the long-term clinical efficacy of these agents. In the clinical setting, these agents should be reduced periodically or discontinued to determine ongoing need. In addition, environmental, social, or behavioral methods of reducing agitated behaviors need to be explored as an adjunct to any medication trial.