Management of metastatic Wilms tumor: an eleven year experience

During the last 11 years, 101 patients of Wilms tumor were seen. Of these, 13 patients had metastatic disease at onset while 24 patients presented with relapse at a latter date. Seven patients have been cured, all had favourable histology. The risk factors associated with relapse were found to be unfavourable histology, lymph node involvement, age more than 6 years, diffuse spill, capsular and vascular invasion, and aneuploidy. Of the 18 patients who had relapsed, 14 were found to be aneuploid. Judicious use of various therapeutic options like radiotherapy to metastatic sites, second look surgery, resection of pulmonary metastasis and use of cis-platinum, VP-16 and Ifosfamide as "alternative chemotherapy protocols" were used to achieve cure in these advance cases.

Transperitoneal closure of the internal ring in incarcerated infantile inguinal hernias

Over a 6-year period, 14 infants with a total of 16 inguinal hernias (IH) underwent transperitoneal closure of the internal ring (TPIR). This was performed through a minilaparotomy, using a purse-string suture placed around the internal ring from within. A difficult inguinal dissection of an edematous and friable spermatic cord was avoided. TPIR was performed for incarceration in 13 of the infants and for recurrence of the hernia within 24 hours of herniotomy in one. There were no intraoperative problems, and during follow-up there was no evidence of testicular atrophy or recurrence of the hernia. This suggests that TPIR is a reliable and safe operation in babies for whom the alternative inguinal approach would be difficult. These situations include hernias that are irreducible and early recurrence in which dissection of the cord would risk damage to the vas deferens or testicular vessels.

Inguinal herniotomy in young infants, with emphasis on premature neonates

Over a period of 6 years, 251 infants under 6 months of age underwent repair of inguinal hernias (IH; n = 311). There were 241 males and 10 females. Incarceration occurred in 59 infants (24%), one of whom had bilateral incarceration. As a result of the authors' policy to operate on infantile IH within 7 days of diagnosis, only 6% of the incarcerations occurred in already diagnosed cases. Sedation and taxis did not reduce the hernia in 22 cases (38%); transperitoneal closure of the internal ring was performed in 14 of these. Eighty-nine infants (36%) were born premature; thirty-nine (41%) of these had been ventilated before, a possible cause of the hernia. Bilateral presentation was more common in the premature infants (35% v 17%); surprisingly, incarceration was less common (13% v 24%). Hence, the policy of delaying herniotomy until discharge from the neonatal unit was justified. During follow-up, six recurrences were noted and two cases of testicular atrophy.

Incidence of Nelson's syndrome and residual adrenocortical function in patients of Cushing's disease after bilateral adrenalectomy

Eighteen patients of Cushing's Disease, who had undergone bilateral "total" adrenalectomy 2 to 10 years back, were evaluated for residual adrenocortical function and for any evidence of Nelson's Syndrome. Surprisingly, all patients were discovered to have measurable plasma cortisol, albeit in the subnormal range. The standard criteria for accepting "completeness of adrenalectomy" were fulfilled in 16 patients. It was possible to wean one patient off replacement therapy. Thus, the dose of replacement steroids needs to be regulated according to the blood steroid levels in order to avoid unnecessary hypercortisolism. Radiological evidence of pituitary tumor diagnosed Nelson's Syndrome in 2 patients. Nelson's Syndrome was further suspected in 8 others who showed pigmentation. One of these had an enlarged sella and an erosion of the dorsum sellae, but had a normal CT scan. Another patient had evidence of incidental pituitary pathology (incidentaloma) which resolved spontaneously. Contrast enhanced CT scans of the sella are necessary for early detection of Nelson's Syndrome.

The chemotherapy of rodent malaria. XLIX. The activities of some synthetic 1,2,4-trioxanes against chloroquine-sensitive and chloroquine-resistant parasites. Part 2: Structure-activity studies on cis-fused cyclopenteno-1,2,4-trioxanes (fenozans) against drug-sensitive and drug-resistant lines of Plasmodium berghei and P. yoelii ssp. NS in vivo

The activity of 51 synthetic cis-fused cyclopenteno-1,2,4-trioxanes has been examined against drug-sensitive and chloroquine-resistant malaria parasites in vivo. Some of them display high levels of blood schizontocidal activity when administered orally or subcutaneously. They retain their activity against lines of parasites that are resistant to widely differing antimalarials such as 4-aminoquinolines, aminoalcohols, dihydrofolate reductase inhibitors and artemisinin. The most potent compound of the present series is cis-(+/-)-4a,7a-dihydro-6,7a-di(p-fluorophenyl)spiro [cyclopentane-3,3'-7H-cyclopenta-1,2,4-trioxin], otherwise known as Fenozan-50F.

Correlates of nonadherence to hypertension treatment in an inner-city minority population

OBJECTIVE

Adherence to treatment is a key factor in achieving blood pressure control among hypertensives. We examined correlates of nonadherence to hypertension treatment in an inner-city minority population.

METHODS

Subjects (n = 202) were interviewed as part of a case-control study of severe, uncontrolled hypertension conducted in two New York City hospitals in 1989-91. All subjects were African American or Hispanic. Self-reported nonadherence to drug treatment for hypertension was measured using a five-item scale, and the sample was dichotomized as more (n = 87) or less (n = 115) adherent. Multiple logistic regression analysis was used to adjust for demographic and other covariates.

RESULTS

Nonadherence was associated with having blood pressure checked in an emergency room (adjusted odds ratio [OR] = 7.9; 95% confidence interval [CI] = 1.75, 35.77; P < .01), lack of a primary care physician (adjusted OR = 2.9; 95% CI = 1.37, 6.02; P < .01), current smoking (adjusted OR = 2.4; 95% CI = 1.10, 5.22; P = .03), and younger age (adjusted OR = 1.03, 95% CI = 1.00, 1.06; P = .03).

CONCLUSIONS

Changing the locus of care for hypertension from emergency rooms to primary care physicians may improve adherence to hypertension treatment in minority populations.

Predisposing factors for severe, uncontrolled hypertension in an inner-city minority population

BACKGROUND

Hypertensive emergency and urgent hypertension are the most severe forms of uncontrolled hypertension and are now seen predominantly in poor, minority populations. We studied the characteristics of the medical care received by patients with these conditions in order to identify risk factors for severe, uncontrolled hypertension.

METHODS

Using a case-control study design, we interviewed 93 patients with severe, uncontrolled hypertension who presented in the hospital emergency room and 114 control patients with hypertension; both groups were seen at two New York City hospitals from 1989 through 1991. All the patients were black or Hispanic. Multiple logistic-regression models were used to adjust for age, sex, race or ethnic background, education, smoking status, alcohol-related problems, and use of illicit drugs during the previous year.

RESULTS

After additional adjustment for lack of health insurance, severe, uncontrolled hypertension was found to be more common among patients who had no primary care physician (adjusted odds ratio, 3.5; 95 percent confidence interval, 1.6 to 7.7) and among those who did not comply with treatment for their hypertension (adjusted odds ratio, 1.9; 95 percent confidence interval, 1.4 to 2.5). Lack of health insurance was marginally associated with severe, uncontrolled hypertension (adjusted odds ratio, 1.9; 95 percent confidence interval, 0.8 to 4.6) after adjustment for lack of a primary care physician and noncompliance with antihypertensive treatment. Patients without a primary care physician and without health insurance were more likely to have their blood pressure checked and receive prescriptions for blood-pressure medications in emergency rooms than in physicians' offices or clinics.

CONCLUSIONS

Characteristics of both the health care system and patients' behavior are associated with severe, uncontrolled hypertension. Improving access to primary care physicians, through health insurance or other means, may be an effective strategy for improving control of hypertension in disadvantaged minority populations.

Proxy respondents in reproductive research: a comparison of self- and partner-reported data

The quality of proxy reporting was assessed among 136 prenatal patients and their spouse/partners recruited from the obstetric services of a New Jersey hospital between 1985 and 1987. The concordance, sensitivity, and specificity of proxy reports about partners' occupation, smoking, and drinking were examined in relation to self-reports. Overall, private patients provided better proxy data than did clinic patients, and women provided better data than did men. No consistent effects on the quality of proxy reports were found in relation to age, level of education, marital status, or length of cohabitation. Partners' recent job titles appeared to be quite accurately reported, whereas partners' smoking and drinking patterns were less well-reported. For alcohol use in particular, there was evidence of considerable misclassification resulting from proxy reports even when kappa statistics and intraclass correlation coefficients suggested good agreement. Use of proxy respondents is unnecessary in reproductive studies and should be avoided when it may produce misleading results. Our data indicate that private prenatal patients and their partners can give reasonable proxy reports about job titles and smoking, but not about alcohol use. The high proportion of clinic patients who did not refer a partner (or whose partners could not be contacted) limits the generalizability of our results for this group and gives cause for concern about collecting proxy information from clinic populations.

Effect of post-hypoxic acclimatization on extremity temperature during exposure to acute cold stress in man

Twelve male volunteers aged 20-28 yr, who were physically fit for high altitude duties were studied. Recordings of oral temperature, mean skin temperature, extremity temperature, O2 consumption and heart rate were taken in a thermoneutral room (26 degrees +/- 2 degrees C) and cold room (6 degrees-8 degrees C) initially; after 4 wk stay at 3353 m (502 mm Hg); again after 4 wk at 4115 m (455 mm Hg); and finally after return to Delhi (740 mm Hg). The oral temperature, mean skin temperature, oxygen consumption and heart rate did not show any significant difference from their initial sea level values recorded in the thermoneutral room or the cold room. It may be concluded that our subjects did not exhibit any degree cold acclimatization when retested at sea level. A significant elevation (P less than 0.001) of extremity temperature observed during retest in cold might be due to some degree of vasodilatation through relaxation of constrictor tone that might have taken place during exposure to hypoxia at high altitude.

Quinazolyl benzophenothiazines as potential antiviral agents

The reaction of anthranilic acid with excess of benzoylchloride in the presence of pyridine yielded 2-phenyl(3H) 4-oxo-3,1-benzoxazine(I). Interaction of (I) with 2-aminoethanol afforded 2-phenyl-3-hydroxy-ethyl(3H) 4-oxo-quinazoline (II). The condensation of (II) with beta-naphthol in the presence of conc. H2SO4 gave 1-(2'-phenyl-3'-ethyl-4'-oxo-quinazolyl) beta-naphthol (III). The reaction of (III) with primary aromatic amines in the presence of anhydrous zinc-chloride afforded 1-(2'-phenyl-3'-ethyl-4'-oxo-quinazolyl)-beta-naphthyl phenyl amine (IV). When (IV) was heated with sulphur and iodine, 1-(2'-phenyl 3'-ethyl -4'-oxo-quinazolyl)-benzophenothiazine (V) was obtained. All the five synthesised benzophenothiazines were screened for their antiviral activity and two compounds exhibited significant inhibition of virus multiplications.

Influence of sex hormones on parathion toxicity in rats: antiacetylcholinesterase activity of parathion and paraoxon in plasma, erythrocytes, and brain

Administration of parathion resulted in a greater inhibition of acetylcholinesterase (AChE) activity of plasma, erythrocytes, and brain in female rats than in male rats. No sex-related difference was observed in the antiacetylcholinesterase activity of paraoxon, an active metabolite of parathion. Gonadectomy increased the susceptibility of males but had no perceptible effect on females, resulting in comparable inhibition of AChE by parathion in both sexes. Administration of testosterone led to recovery from increased sensitivity to the antiacetylcholinesterase activity of parathion in castrated males and afforded partial protection to ovariectomized females. On the other hand, administration of estradiol further enhanced the enzyme inhibition by parathion in castrated males but had no significant effect on that in ovariectomized females. Alterations in the status of sex hormones did not affect the antiacetylcholinesterase activity of paraoxon in plasma and erythrocytes. However, inhibition of AChE activity by paraoxon was significantly higher in brains of gonadectomized rats than those of normal rats and the effect was reversible on administration of the respective sex hormones. The results indicate that testosterone plays an important role in determining parathion toxicity (as reflected by its antiacetylcholinesterase activity), probably by activating the oxidative cleavage of the insecticide into nontoxic metabolites.

Complete amino acid sequence of the ADP/ATP carrier from beef heart mitochondria

The complete primary structure of the ADP/ATP carrier from beef heart mitochondria is described. Cyanogen bromide cleaves the protein into a long, N-terminally blocked fragment with Mr 22,000 (CB1) and several small peptides. The primary information was derived from liquid-phase sequencing of tryptic peptides obtained from the maleylated carrier protein and the citraconylated CB1 fragment, as well as from cleavage products with Staphylococcus aureus protease. The multitude of thermolysinolytic, tryptic, chymotryptic and peptic peptides was sequenced by manual methods. They rendered overlaps and further supported already known partial sequences. Also, the bridge between the published acidolytic C-terminal fragment A2 was thus obtained.

Contribution of lactic acid by the ampullary and isthmic parts of rabbit Fallopian tube under altered hormonal conditions

The capability of the ampullary and isthmic parts of the rabbit Fallopian tube to contribute lactic acid (LA) to the tubal lumen was examined using an in vitro method of study. In addition concomitant study was also made using the uterus. It was found that in the oestrous rabbit, the isthmus contributed LA at a higher rate than that of the ampulla; the uterine contribution was minimal. Ovariectomy reduced while exogenous oestrogen enhanced this ability in all the three tissues. In mated post-ovulatory rabbits the contributory efficiency of either tubal part changed and appeared to exhibit a peak value in the presence of the ovum; the uterus showed no such changes. This is discussed in relation to the ability of the egg to secure its energy source until it attained morula/the pre-blastocyst stage.