To report or not to report: emergency services response to elder abuse

PURPOSE

Prehospital emergency medical services (EMS) personnel, as initial responders to calls for assistance, are in an ideal position to identify abused or neglected elderly. A survey of prehospital personnel in Michigan was conducted to determine the scope of this problem, levels of awareness, and willingness to report cases of elder abuse.

METHODS

The study population was a random sample of 500 prehospital personnel throughout one state. A blinded, self-administered survey was completed by emergency medical technicians (EMTs) and paramedics outlining their practice characteristics, prevalence of abuse in their community, and training available specific to elder abuse. Attitudes concerning the understanding and reporting of geriatric abuse were measured using a Likert-type scale.

RESULTS

A total of 156 surveys (31%) was completed; 68% of the respondents were paramedics. Respondents had an average of 8.7 years (range: 9 months-30 years) of prehospital emergency-care experience, and evaluated an average of 11 patients (range: 1-59) older than 65 years of age each week. Seventy-eight percent had seen a suspected case of elder abuse or negligence during their careers; 68% had seen a case during the past 12 months (mean: 2.3 cases/yr; range: 0-24 cases/yr). However, surveyed personnel reported only 27% of suspected cases to authorities last year (mean: 0.62 cases/yr). Reasons for not reporting included 1) unsure which authorities take reports; 2) unclear definitions; 3) unaware of mandatory reporting laws; and 4) lack of anonymity. Ninety-five percent of respondents stated that training related to elder abuse was not available through their EMS agency.

CONCLUSION

Paramedics and EMTs lack complete understanding of their role in the identification and reporting of elder abuse. This information should be emphasized during EMS training and reinforced through continuing education.

Incidence of familial melanoma and MLM2 gene

The overall incidence of melanoma is increasing world wide. We investigated whether there has been an increase in familial melanoma by studying age at onset among different birth cohorts in 18 melanoma kindreds linked to a predisposition gene (MLM2) on chromosome 9. The cumulative incidence of melanoma was 21-fold higher (95% CI 5.2-84.6) among subjects born after 1959 than in those born before 1900. The expected age of onset of the group born after 1959 was 24 years earlier (21.0 vs 45.0 years). These data support the notion that phenotypic penetrance of the MLM2 gene is increasing, presumably as a result of the interaction of sunlight exposure and mutation at this locus.

Dexamethasone differentially affects interleukin 1 beta- and cyclic AMP-induced nitric oxide synthase mRNA expression in renal mesangial cells

Inducible nitric oxide synthase (iNOS) is expressed in renal mesangial cells in response to two principal classes of activating signals that interact in a synergistic fashion. These two groups of activators comprise inflammatory cytokines such as interleukin (IL)-1 beta or tumour necrosis factor alpha and agents that elevate cellular levels of cyclic AMP (cAMP). We examined whether dexamethasone differentially affects iNOS induction in response to IL-1 beta and a membrane-permeable cAMP analogue, N6,O-2'-dibutyryladenosine 3',5'-phosphate (Bt2cAMP). Nanomolar concentrations of dexamethasone suppress IL-1 beta- as well as Bt2cAMP-induced iNOS protein expression and production of nitrite, the stable end product of nitric oxide (NO) formation. In contrast, dexamethasone prevents induction of iNOS mRNA in response to Bt2cAMP without affecting IL-1 beta-triggered increase in iNOS mRNA levels. These data suggest that dexamethasone acts at different levels, depending on the stimulus used to suppress iNOS induction in mesangial cells.

Two distinct signaling pathways trigger the expression of inducible nitric oxide synthase in rat renal mesangial cells

The expression of nitric oxide synthase (NOS; EC 1.14.13.39) is induced in rat glomerular mesangial cells by exposure to the inflammatory cytokine interleukin 1 beta (IL-1 beta) or cAMP-elevating agents. Stimulation with IL-1 beta alone leads to an approximately 40-fold increase in NOS activity and nitrite synthesis, whereas the elevation of cAMP with forskolin, cholera toxin, salbutamol, or dibutyryl-cAMP for 24 h resulted in a 2- to 12-fold increase in NOS activity. Moreover, the combinations of IL-1 beta with each of the cAMP-elevating agents greatly enhanced NOS activity in a synergistic fashion. Northern-blot analysis demonstrated a single band of approximately 4.5 kb for the NOS mRNA in rat mesangial cells. IL-1 beta increased NOS mRNA levels in a dose- and time-dependent fashion with a peak of NOS mRNA at 24 h. Dibutyryl-cAMP also increased NOS mRNA levels in mesangial cells in a dose- and time-dependent manner. Furthermore, combination of IL-1 beta and forskolin revealed a strong synergy with maximal mRNA levels 12 h after stimulation. Nuclear run-on transcription experiments suggest that IL-1 beta and cAMP synergistically interact to increase NOS gene expression at the transcriptional level. Furthermore, message stability studies established that NOS mRNA induced by cAMP has a longer half-life than the IL-1 beta-induced message. Moreover, cAMP exposure markedly prolonged the half-life of NOS mRNA from 1 h to 3 h. These data suggest that the level of NOS mRNA is controlled by at least two different signaling pathways, one involving cAMP and the other being triggered by cytokines such as IL-1 beta. The two pathways act synergistically and thus potently up-regulate the expression of inducible NOS in rat mesangial cells.

[Concentration of biocides in indoor rooms using pyrethroids as an example]

Pyrethroids are an analogous substance group to one of the oldest known, naturally occurring insecticides pyrethrum and have replaced a number of pesticides such as Lindane, DDT and PCP on the market. Biocides are more persistent indoors than in nature, which could lead to permanent health hazards for the people concerned. Within a few days after application pyrethroids are rarely detected in room air but can be traced for a long time on textiles, furniture and in dust particles (3, 8). The investigation results of approx. 100 analyses from dust and carpet samples show that approx. 1/3 of these samples are positive for at least one pyrethroid and contain a concentration of > 2 mg substance per kg sample. The evaluation of 35 air samples taken from rooms where substances containing pyrethroids had been used at least a month prior to the investigation (the samples were sampled on active charcoal or Chromosorb) showed that pyrethroids could no longer be traced above the detection limit of 0.05-0.1 micrograms/m3. We therefore think that when investigating a contamination of rooms by biocides it is more advisable to determine pyrethroid and its synergists in the suspended dust portion and corresponding dust sample rather than analysing air by adsorption to active charcoal, Chromosorb or other carrier materials. From the observed concentrations of biocides one could conclude that in an indoor setting secondary contamination by biocides plays a more significant role in the total-body-load than that of air contamination.

'Routine' antenatal care

The concept of antenatal care is a good model of preventive health targeted towards primary and secondary prevention of diseases and pathological conditions during pregnancy and delivery. A critical evaluation of antenatal care programs demonstrated that these are generally associated with a wide range of positive effects, although the type of care provider is not. However, research methodological limitations such as the selection bias (more care is received by healthier women who will have better outcomes anyway), cannot be ruled out as an explanation for the positive results.

Freestanding ambulatory surgery: cost-containment winner?

In many states, freestanding, ambulatory surgery centers (ASCs) are being permitted to provide overnight, postoperative recovery and observation services. As a result, ASCs are now able to perform surgical procedures that were once the exclusive province of hospital-based outpatient surgery departments. As an analysis of data gathered in Florida and North Carolina illustrates, freestanding ASCs usually have lower charges than their hospital-based counterparts. This finding suggests that hospitals will have to take steps to control their ambulatory surgery costs if they want to compete successfully in the race for ambulatory surgery dollars.

Who cares for Missouri's Medicaid nursing home residents? Characteristics of attending physicians

OBJECTIVE

To describe the characteristics of physicians attending Medicaid recipients in Missouri's certified nursing homes (NH).

DESIGN

Retrospective survey of multiple data sources.

SETTING

Missouri's certified nursing homes.

PARTICIPANTS

1,339 physicians attending 22,452 Medicaid recipients.

MEASUREMENTS

Physician characteristics were determined by reviewing a roster of medical directors of NHs compiled by the Missouri Department of Social Services' Division of Aging and physician directories compiled by the Missouri State Board of Registration for the Healing Arts, the AMA, the AOA, the ABFP, and the ABIM. Physician clinical activity was determined by examining NH inspection of care reports compiled by the Missouri Department of Social Services' Division of Aging.

RESULTS

Each physician attended a mean of 16.8 and a median of six Medicaid recipients in the nursing home. The skewed distribution is reflected by 426 (31.8%) of the physicians attending only one or two residents, and 28 (2.1%) of the physicians attending 100 or more residents. Twenty-seven percent of the state's licensed osteopaths (DOs, 362) attended nursing home patients, compared with 11% of allopathic physicians (MDs, 977). Significantly more DOs than MDs attended more than the median number of patients (57% vs 45%, P < 0.001). Half were attended by the 605 (45%) physicians without board certification. Of those who were board certified, family physicians were more likely to include Medicaid nursing home patients in their practices than internists (43% vs 18%, P < 0.001). Physicians licensed for 11 to 20 years and rural physicians had the heaviest patient loads.

CONCLUSIONS

Many doctors are caring for very few nursing home residents while a few doctors may be caring for too many patients. In addition, half the Medicaid recipients residing in Missouri's nursing homes in 1988 were attended by physicians without board certification, and almost one-third were attended by physicians who may be retiring between 2000 and 2010.

Adjudicated pricing--when rates are challenged in court

When the courts become involved in taking hospitals to task for their prices, hospital financial officers should prepare themselves for the unpleasant, potentially costly, and time-consuming legal dance that awaits them. The authors examine the pitfalls of judicial regulation of hospital charges and offer suggestions on how hospitals can avoid legal challenges or best prepare to meet them.

Mapping the binding domain of a myosin II binding protein

The way in which actin and myosin II become localized to the contractile ring of dividing cells resulting in cleavage furrow formation and cytokinesis is unknown. While much is known about actin binding proteins and actin localization, little is known about myosin localization. A 53-kDa (53K) polypeptide present in the sea urchin egg binds to myosin II in a nucleotide-dependent manner and mediates its solubility in vitro [Yabkowitz, R., & Burgess, D.R. (1987) J. Cell Biol. 105, 927-936]. The binding site of 53K on the myosin molecule was examined in an effort to understand the mechanism of 53K-induced myosin solubility and its potential function in myosin regulation. Blot overlay and chemical cross-linking techniques utilizing myosin proteolytic fragments indicate that 53K binds to fragments proximal to the head-rod junction of myosin. Fragments distal to the head-rod junction do not bind 53K. In addition, the binding of 53K to myosin largely inhibits protease digestion that produces the head and rod fragments. The binding of 53K to the head-rod domain of myosin may be critical in regulation of myosin conformation, localization, assembly, and ATPase activity.

Localization of type X collagen in canine growth plate and adult canine articular cartilage

Type X collagen was extracted from ends of canine growth plates by pepsin digestion after 4 M guanidine hydrochloride extraction, purified by stepwise salt precipitation (2.0 M NaCl in 0.5 M acetic acid), and chromatographed on a Bio-Gel A1.5 M column in 1.0 M CaCl2. Without reduction on sodium dodecyl sulfate (SDS) polyacrylamide gels, the preparation yielded a single, high-molecular-weight (mol wt) band; after reduction, a single band of relative mol wt 5.0 x 10(4) was found. Polyclonal sera were raised against the purified collagen and used in the immunolocalization of canine type X collagen. As expected, indirect immunoperoxidase (IP) or indirect immunofluorescent staining with the polyclonal sera demonstrated that most of the immunoreactivity was localized in the zone of provisional calcification of the growth plate and in cartilage remnants in the metaphyseal region of the physis. A progressive decrease in staining toward the diaphysis of the fetal canine long bone was apparent as the trabecular structures were remodeled to bone. Unexpectedly, type X collagen was also detected in the zone of calcified, mature articular cartilage. It was concentrated in the pericellular matrix of the chondrocytes, appeared at or just above the tidemark, and was expressed immediately before mineralization. Identification of type X collagen in both the canine growth plate and the zone of calcified articular cartilage suggests that cells in the deep layer of cartilage and in the zone of calcified cartilage in the adult animal retain some characteristics of a growth plate and may be involved in regulation of mineralization at this critical interface. The expression of growth plate-like properties would allow the deep chondrocytes of mature articular cartilage to play a role in remodeling of the joint with age and in the pathogenesis of osteoarthritis.

Safe, stable, whole blood samples for quality assessment of glucose measurement by non-laboratory staff

A whole blood control material has been used to assess the analytical performance of non-laboratory staff who use glucose meters in clinical areas. It is prepared from sterile horse blood which is readily available from a commercial source. There are no known infection or disease transmission risks to users. When the material is stabilized by the addition of sodium fluoride less than 3% loss of glucose over 48 h is observed from an initial value of 10 mmol/L. However, we prefer to stipulate that the glucose is measured on the day of receipt. The material has been used successfully with Reflolux IIM meters and B-M sticks (Boehringer Mannheim, UK) for over a year in our hospital.

The morbidity of long-term seizure monitoring using subdural strip electrodes

The authors report a prospective study of morbidity associated with long-term seizure monitoring using subdural strip electrodes. Three hundred fifty patients were divided into two groups: 175 patients received antibiotics intravenously during the entire period that the electrodes were implanted, and 175 patients received one dose of antibiotics on the morning of surgery. In the group given continuous antibiotic coverage there were two cases of meningitis, both treated without sequelae. In the group receiving one dose of antibiotics, one patient had a brain abscess and three had superficial wound infections. There were no other instances of major morbidity or mortality in either group of patients. The total morbidity rate for both serious and minor complications was 0.85%.

Performance of techniques used to detect drugs of abuse in urine: study based on external quality assessment

Twenty-five samples of lyophilized urine from the U.K. External Quality Assessment Scheme for Drugs of Abuse were analyzed by an average of 95 laboratories between April 1987 and December 1989. Samples contained mixtures of analytes and included replicated concentrations of morphine, methadone, amphetamine, and cocaine at 0, 1, 2, and 5 mg/L and of benzoylecgonine at 0, 0.4, 1, 2, and 4 mg/L. Some chromatographic techniques were inadequate for detecting morphine, amphetamine, cocaine, and benzoylecgonine at the lower concentrations of analytes studied: gas-liquid chromatography was least sensitive for morphine; in-house thin-layer chromatography (TLC) was least sensitive for the other analytes. Few significant differences in specificity were detected between techniques, although significant interference from structurally related compounds was demonstrated in assays of morphine, methadone, and amphetamine. Exceptions were the Boehringer (BCL) test for opiates and TLC applied to amphetamine and benzoylecgonine, which demonstrated considerable lack of specificity.

Performance of techniques used to detect drugs of abuse in urine: study based on external quality assessment

Twenty-five samples of lyophilized urine from the U.K. External Quality Assessment Scheme for Drugs of Abuse were analyzed by an average of 95 laboratories between April 1987 and December 1989. Samples contained mixtures of analytes and included replicated concentrations of morphine, methadone, amphetamine, and cocaine at 0, 1, 2, and 5 mg/L and of benzoylecgonine at 0, 0.4, 1, 2, and 4 mg/L. Some chromatographic techniques were inadequate for detecting morphine, amphetamine, cocaine, and benzoylecgonine at the lower concentrations of analytes studied: gas-liquid chromatography was least sensitive for morphine; in-house thin-layer chromatography (TLC) was least sensitive for the other analytes. Few significant differences in specificity were detected between techniques, although significant interference from structurally related compounds was demonstrated in assays of morphine, methadone, and amphetamine. Exceptions were the Boehringer (BCL) test for opiates and TLC applied to amphetamine and benzoylecgonine, which demonstrated considerable lack of specificity.

Magnetic and electrical stimulation of cervical motor roots: technique, site and mechanisms of excitation

Cervical motor roots and the brachial plexus were excited transcutaneously with magnetic (MagStim) and electrical stimulation (ElStim) applied dorsally over the spine and over the supraclavicular fossa (Erb's point). The compound muscle action potentials (CMAPs) from the abductor digiti minimi (ADM) and the biceps muscles (BICEPS) could be evoked with either stimulating technique in all 52 subjects tested. With MagStim over the spinous process C7, greater CMAPs were obtained from ADM (p less than or equal to 0.0001, paired t test) and BICEPS (p less than or equal to 0.005) when the inducing current in the coil as viewed from behind was clockwise for the right arm and vice versa. ElStim with the cathode over C7/T1 and the anode directed cranially provided greater CMAPs from the ADM (p less than or equal to 0.0001) and smaller CMAPs from the BICEPS (p less than or equal to 0.01) than with the inverse polarity. MagStim of the cervical roots provided CMAPs which were smaller from ADM (p less than or equal to 0.0001), and greater from BICEPS (p less than or equal to 0.0001), than ElStim (cathode C7/T1), whereas latencies did not differ significantly (p less than or equal to 0.3). When comparing ElStim and MagStim applied over Erb's point, the former yielded greater CMAPs and 0.5 ms longer latencies from both the ADM and BICEPS (p less than or equal to 0.001). From these data and additional studies in four patients, including direct intraoperative root stimulation in one of them, it is concluded that ElStim and MagStim over the spine excite the motor roots at a similar site, that is, within a few cm outside the intervertebral foramina. The site of stimulation is difficult to predict and depends on the placement of the stimulating devices and the intensities used. In contrast, MagStim of the brachial plexus over Erb's point occurs on average about 3.5 cm distal to the site of ElmStim.

Membrane-associated 41-kDa GTP-binding protein in collagen-induced platelet activation

Initially we established that the binding of collagen to human blood platelets stimulates both the rapid loss of PIP2 and the generation of inositol-4,5-bisphosphate (IP2) and inositol-1,4,5-triphosphate (IP3). These results indicate that the binding of collagen stimulates inositol phospholipid-specific phospholipase C during platelet activation. The fact that GTP or GTP-gamma-S augments, and pertussis toxin inhibits, collagen-induced IP3 formation suggests that a GTP-binding protein (or (or proteins) may be directly involved in the regulation of phospholipase C-mediated phosphoinositide turnover in human platelets. We have used several complementary techniques to isolate and characterize a platelet 41-kDa polypeptide (or polypeptides) that has a number of structural and functional similarities to the regulatory alpha i subunit of the GTP-binding proteins isolated from bovine brain. This 41-kDa polypeptide (or polypeptides) is found to be closely associated with at least four membrane glycoproteins (e.g., gp180, gp110, gp95, and gp75) in a 330-kDa complex that can be dissociated by treatment with high salt plus urea. Most important, we have demonstrated that antilymphoma 41-kDa (alpha i subunit of GTP-binding proteins) antibody cross-reacts with the platelet 41-kDa protein (or proteins) and the alpha i subunit of bovine brain Gi alpha proteins, and blocks GTP/collagen-induced IP3 formation. These data provide strong evidence that the 41-kDa platelet GTP-binding protein (or proteins) is directly involved in collagen-induced signal transduction during platelet activation.

Tumor necrosis factor alpha/cachectin stimulates eosinophil oxidant production and toxicity towards human endothelium

Eosinophils (EOs) participate in a variety of inflammatory states characterized by endothelial cell damage, such as vasculitis, pneumonitis, and endocarditis. We find that 100 U/ml TNF-alpha/cachectin (TNF), a concentration attainable in the blood of humans with parasitic infestations, stimulates highly purified populations of EOs to damage human umbilical vein endothelial cells (HUVEC), a model of human endothelium. This TNF-dependent EO cytotoxicity is strongly inhibited by heparin and methyprednisolone but unaffected by the platelet-activating factor antagonist BN52012 or scavengers of superoxide anion and H2O2, superoxide dismutase and catalase. However, addition of a physiologically relevant concentration of Br- (100 microM) enhances EO/TNF damage to HUVEC, implicating the possible participation of EO peroxidase (EPO) in the killing mechanism. EOs adherent to FCS-coated plastic wells more than double their production of superoxide anion and the cytotoxic EPO-derived oxidant HOBr when exposed to TNF, showing that TNF activates the respiratory burst of EOs attached to a "physiologic" surface. Unlike PMNs, EOs were not irreversibly activated to kill unopsonized endothelium by previous exposure to TNF, and did not degranulate or upregulate CR3 expression as detected by Mo1 in the presence of 100 U/ml TNF. HUVEC exposed 18 h to TNF were considerably more susceptible to lysis by PMA-activated EOs and reagent H2O2, demonstrating a direct effect of TNF upon endothelium, perhaps through inhibition of antioxidant defenses. These findings suggest that abnormally elevated serum levels of TNF may provoke EOs to damage endothelial cells and thereby play a role in the pathogenesis of tissue damage in hypereosinophilic states.

Ultrasonic assessment of injuries to the lateral complex of the ankle

A prospective study of 114 patients who injured the lateral complex of their ankles. All patients were subjected to ultrasound scanning within 48 h of their injury under double blind conditions. The authors' results suggest that the sensitivity of the ultrasound diagnosis approaches that of conventional radiology, if used properly. Furthermore, ultrasonic scanning is a useful adjuvant to clinical assessment of patients with regards to selection for further radiological examination. A case is also made for firms in the medical physics arena to develop suitable hardware in the diagnostic ultrasonic field for fracture management.

Dermatomyositis associated with multifocal lipoatrophy

A 10-year-old boy had juvenile dermatomyositis and multiple asymmetric lesions of lipoatrophy. The lipoatrophy had occurred without preceding clinical evidence of inflammation. Biopsy specimens of the skin confirmed a lobular panniculitis. This is the first report of the association of lipoatrophy and juvenile dermatomyositis.

A survey of drugs of abuse testing by clinical laboratories in the United Kingdom. Steering Committee for the UK-External Quality Assessment Scheme for Therapeutic Drug Assays

An external quality assessment survey of testing facilities in UK clinical laboratories for the detection of drugs of abuse was made with nine freeze-dried samples of urine containing representative drugs with their metabolites from the following seven classes; amphetamines and stimulants, barbiturates, cannabinoids, cocaine, minor tranquillisers, opiates and non-opiate narcotics. Reports were received from 120 laboratories. Thirty six per cent of laboratories reported on all seven drug classes and 71% on the five classes excluding cannabinoids and cocaine. A single drug screening technique was used by 32% of laboratories whilst 46% were able to perform tests by both immunological and chromatographic techniques. There was a mean level of false positive reporting of 4.3% and an observed level of false negative reports of 8.4%, the latter underestimating the true frequency. The minor tranquillisers, cocaine and benzoyl ecgonine were the most frequently missed analytes. Several false reports had important potential implications for patient care.

Interactions between a lymphoma membrane-associated guanosine 5'-triphosphate-binding protein and the cytoskeleton during receptor patching and capping

In this study we have used several complementary techniques to isolate and characterize a lymphoma membrane-associated 41-kDa protein that shares a number of structural and functional similarities with the alpha i subunit of the guanosine 5'-triphosphate (GTP)-binding protein (e.g., Gi alpha-like protein). In addition, using permeabilized lymphoma cells, we have found that: 1) GTP or GTP-tau-S augments, and pertussis toxin inhibits, phospholipase C (PLC) activity and receptor capping; and 2) the addition of lymphoma 41-kDa Gi alpha-like protein stimulates PLC activity and receptor patching/capping, and reverses the inhibitory effect of pertussis toxin on both activity and receptor patching/capping. Additional cytochemical and biochemical data indicate that the lymphoma 41-kDa protein is closely associated with several cytoskeletal proteins (e.g., actin, myosin, and fodrin) all of which colocalize under receptor cap structures. Furthermore, both the 41-kDa-mediated phospholipase C activity and receptor patching/capping are inhibited by cytochalasin D (a microfilament disrupting drug) and W-7 drug (a calmodulin inhibitor). Together, these data provide strong evidence for a functional association between the lymphoma membrane cytoskeleton and the 41-kDa (Gi alpha-like) protein. Specifically, this association appears to be required for the activation of phospholipase C that results in inositol triphosphate production, subsequent internal Ca2+ release, and finally surface receptor patching and capping.

Interactions between a lymphoma membrane-associated guanosine 5'-triphosphate-binding protein and the cytoskeleton during receptor patching and capping

In this study we have used several complementary techniques to isolate and characterize a lymphoma membrane-associated 41-kDa protein that shares a number of structural and functional similarities with the alpha i subunit of the guanosine 5'-triphosphate (GTP)-binding protein (e.g., Gi alpha-like protein). In addition, using permeabilized lymphoma cells, we have found that: 1) GTP or GTP-tau-S augments, and pertussis toxin inhibits, phospholipase C (PLC) activity and receptor capping; and 2) the addition of lymphoma 41-kDa Gi alpha-like protein stimulates PLC activity and receptor patching/capping, and reverses the inhibitory effect of pertussis toxin on both activity and receptor patching/capping. Additional cytochemical and biochemical data indicate that the lymphoma 41-kDa protein is closely associated with several cytoskeletal proteins (e.g., actin, myosin, and fodrin) all of which colocalize under receptor cap structures. Furthermore, both the 41-kDa-mediated phospholipase C activity and receptor patching/capping are inhibited by cytochalasin D (a microfilament disrupting drug) and W-7 drug (a calmodulin inhibitor). Together, these data provide strong evidence for a functional association between the lymphoma membrane cytoskeleton and the 41-kDa (Gi alpha-like) protein. Specifically, this association appears to be required for the activation of phospholipase C that results in inositol triphosphate production, subsequent internal Ca2+ release, and finally surface receptor patching and capping.

Antiarrhythmic effects of selective beta 1- and beta 2- and nonselective beta-adrenoceptor blockade in normokalaemic and dietary-induced hypokalaemic rats

Hypokalaemia (HK) is a risk factor for development of clinical arrhythmias, and epinephrine (Epi), released after myocardial infarction, may itself induce HK. The effects of selective beta 1- and beta 2-blockade with metoprolol (M) and ICI 118551 (I), respectively, and non-selective blockade with propranolol (P) against early ischaemia-induced arrhythmias were therefore compared in normokalaemic (NK) and dietary-induced HK rats. Plasma Epi, norepinephrine (NE), and K+ levels were also measured. All three blockers [5-10 mg/kg intravenously (i.v.)] were antifibrillatory in NK rats, whereas I and P (2-10 mg/kg) additionally reduced the number of ventricular premature beats. Coronary artery ligation increased plasma Epi levels in both NK an HK rats, but plasma NE increased further in HK rats. HK was also associated with an increased arrhythmia severity and negation of the antifibrillatory action of M. In contrast, I and P retained antiarrhythmic and antifibrillatory effects in HK animals and increased survival. Both I and P increased plasma K+ levels in both NK and HK animals whereas M did not. We concluded that beta 2-receptor-mediated HK after coronary occlusion may play a substantial role in arrhythmogenesis. Protection afforded by beta 2-blocking agents may be due to alleviation of HK in HK rats or to induction of hyperkalaemia in NK rats.

The role of caldesmon in the regulation of receptor capping in mouse T-lymphoma cell

Several complementary techniques, including immunocytochemical and immunobiochemical analyses, two-dimensional gel electrophoresis, and peptide mapping, were used in this study to examine the involvement of caldesmon in lymphocyte receptor capping. We have found a lymphoma 140-kDa polypeptide that is structurally similar to muscle caldesmon, suggesting that this polypeptide may be a lymphoma caldesmon. When lymphoma 140-kDa polypeptide is extracted from permeabilized cells using 25 mM MgCl2, capping is inhibited. Adding the 140-kDa protein or gizzard caldesmon back to the extracted cells restores their ability to cap. These findings suggest that actin-linked regulatory proteins such as caldesmon may be critically important to actomyosin-mediated contraction which, in turn, is responsible for collecting receptors into cap structures.

Assessment of salicylate derivatives for potential use in ulcerative colitis: proposal for a new action of 5-aminosalicylic acid?

The therapeutic efficacy of salicylate drugs for ulcerative colitis in vivo is related to the capacity of each drug to suppress fatty acid oxidation in colonocytes in vitro. The suppression index of fatty acid oxidation (SIFO) was assessed with 17 salicylate drugs of either known or unknown therapeutic efficacy. The high SIFO value of 5-aminosalicylic acid (5-ASA) was reduced to zero when the amino group was replaced with a methyl, nitro, hydroxyl or bromine group. The SIFO of 3-ASA was dose-related and 2- to 3-fold greater than the SIFO of 5-ASA. The antioxidants methyl- or propyl-4-hydroxybenzoate have a high SIFO, but show a 'toxic' action towards colonocytes not observed with 3-ASA, 4-ASA or 5-ASA. A new cellular action proposed for 5-ASA is that acetylation of the amino group of 5-ASA in colonocytes releases free CoA countering sequestration of CoA observed in epithelial cells during active colitis.

Circulating adrenaline and noradrenaline concentrations during exercise in patients with exercise induced asthma and normal subjects

A failure of the usual increase in plasma adrenaline and noradrenaline concentrations during submaximal exercise has been suggested as a contributory cause of exercise induced asthma. Six normal subjects and six asthmatic patients underwent a standard graded maximal exercise test. Measurements of oxygen consumption, minute ventilation, exercise time, blood lactate concentration, and heart rate indicated that the two groups achieved similarly high work loads during exercise. Mean FEV1 fell by 20% in asthmatic patients after exercise. Basal plasma adrenaline concentrations (nmol/l) increased in normal subjects from 0.05 to 2.7 and in asthmatic patients from 0.12 to 1.6 at peak exercise. Noradrenaline concentrations (nmol/l) increased in normal subjects from 2.0 to 14.3 and in asthmatic patients from 1.9 to 13.7 at peak exercise. The increases in adrenaline and noradrenaline in the asthmatic patients did not differ significantly from the increases in normal subjects. Thus a reduced sympathoadrenal response to exercise seems unlikely to be an important mechanism in the pathogenesis of exercise induced asthma.

Evidence for a dual effect by beta-adrenoceptor antagonists on post-exercise airway calibre

The effect of selectivity of beta-adrenoceptor antagonists on resting and post-exercise airway calibre in normal subjects was studied. Eight normal subjects were given atenolol 50 mg, propranolol 80 mg and placebo orally, in random order, double-blind. Specific airways conductance and flow-volume curves (partial and complete) were recorded before, 2 hours after drug administration and after exercise. Neither beta-adrenoceptor antagonist had a measurable effect on lung function tests at rest. The post-exercise increase in flow rates measured from partial flow volume curves was inhibited by propranolol but not by the beta-1-selective adrenoceptor antagonist atenolol, whereas both drugs caused a decrease in specific airways conductance after exercise. Beta-adrenoceptor antagonists may have a dual effect on airway calibre. Firstly, a direct effect on the beta-2 receptors in airway smooth muscle may occur. Secondly, beta-adrenoceptor blockade may, in the large airways, inhibit vagal pre-junctional beta-1 receptors which normally inhibit acetylcholine release at the nerve ending, thereby permitting vagally-induced airway narrowing.

Evidence for a dual effect by beta-adrenoceptor antagonists on post-exercise airway calibre

The effect of selectivity of beta-adrenoceptor antagonists on resting and post-exercise airway calibre in normal subjects was studied. Eight normal subjects were given atenolol 50 mg, propranolol 80 mg and placebo orally, in random order, double-blind. Specific airways conductance and flow-volume curves (partial and complete) were recorded before, 2 hours after drug administration and after exercise. Neither beta-adrenoceptor antagonist had a measurable effect on lung function tests at rest. The post-exercise increase in flow rates measured from partial flow volume curves was inhibited by propranolol but not by the beta-1-selective adrenoceptor antagonist atenolol, whereas both drugs caused a decrease in specific airways conductance after exercise. Beta-adrenoceptor antagonists may have a dual effect on airway calibre. Firstly, a direct effect on the beta-2 receptors in airway smooth muscle may occur. Secondly, beta-adrenoceptor blockade may, in the large airways, inhibit vagal pre-junctional beta-1 receptors which normally inhibit acetylcholine release at the nerve ending, thereby permitting vagally-induced airway narrowing.

'False feet': an alternative to expensive surgical shoes

A method of 'equalising' unequal sized and shaped feet to allow the use of normal shoes of equal size, and permit the purchase of a 'pair' of shoes is described. This makes available a greater choice of normal styles and colours for patients with deformed and unequal feet. It is contrasted with the provision of custom-made surgical shoes and the purchase of two pairs of unequal size shop shoes. The patients and their parents were pleased with the results and the cost savings were considerable.

Neuroleptic malignant syndrome: three episodes with different drugs

This is an illustrative case of a patient with neuroleptic malignant syndrome whom we believe is the first described in the world's literature to have this syndrome on three occasions, each time after having received a different neuroleptic agent.

A lymphoma plasma membrane-associated protein with ankyrin-like properties

In this study we have used several complementary techniques to isolate and characterize a 72-kD polypeptide that is tightly associated with a major mouse T-lymphoma membrane glycoprotein, gp 85 (a wheat germ agglutinin-binding protein), in a 16 S complex. These two proteins do not separate in the presence of high salt but can be dissociated by treatment with 2 M urea. Further analysis indicates that the 72-kD protein has ankyrin-like properties based on the following criteria: (a) it cross-reacts with specific antibodies raised against erythrocyte and brain ankyrin; (b) it displays a peptide mapping pattern and a pI (between 6.5 and 6.8) similar to that of the 72-kD proteolytic fragment of erythrocyte ankyrin; (c) it competes with erythrocyte ghost membranes (spectrin-depleted preparations) for spectrin binding; and (d) it binds to purified spectrin and fodrin molecules. Most importantly, in intact lymphoma cells this ankyrin-like protein is localized directly underneath the plasma membrane and is found to be preferentially accumulated beneath receptor cap structures as well as associated with a membrane-cytoskeleton complex preparation. It is proposed that the ankyrin-like 72-kD protein may play an important role in linking certain surface glycoprotein(s) to fodrin which, in turn, binds to actin filaments required for lymphocyte cap formation.

The safety of the Denis Browne abduction harness in congenital dislocation of the hip

The Denis Browne abduction harness was used in the management of 127 abnormal hips in 104 children at Queen Mary's Hospital for Children from 1966 to 1980, both as the initial treatment for unstable hips recognised soon after birth, and for children presenting later and whose hips first required reduction by gradual abduction in traction. The incidence of significant avascular necrosis was 3.1%, and occurred only in the primary treatment group, emphasising again the need for gentle care of infant hips. There have been no other significant complications and the appliance has functioned well.