Social consequences of manufactured longevity

The signs are that advances in biomedical sciences will add more years of "manufactured time" to life expectancy in industrialised countries, resulting in unprecedented rates of survival into older ages. Increasing longevity will force economic and social changes and the 20th-century revolution in social roles looks set to continue into the 21st century.

Anti-tumor activity of K1-LysPE38QQR, an immunotoxin targeting mesothelin, a cell-surface antigen overexpressed in ovarian cancer and malignant mesothelioma

Mesothelin, a differentiation antigen, is a 40-kD glycosylphosphatidylinositol-linked cell-surface glycoprotein, that is present on the surface of normal mesothelium and is overexpressed in many patients with epithelial ovarian cancer and malignant mesotheliomas. Monoclonal antibody K1 is a murine immunoglobulin G1 that recognizes mesothelin. LysPE38QQR is a truncated form of Pseudomonas exotoxin that lacks the cell-binding domain, but retains the translocation and adenosine diphosphate-ribosylation domains. It has a single lysine residue near the amino terminus that is available for conjugation to antibodies. To prevent chemical conjugation of the antibody to lysine residues at the C-terminus of Pseudomonas exotoxin, the two lysine residues at positions 590 and 606 were mutated to glutamine, and the lysine residue at position 613 was mutated to arginine. Monoclonal antibody K1 was chemically conjugated with LysPE38QQR, by modifying the antibody with sulfosuccinimidyl-4-(N-maleimidomethyl)cyclohexane-1-carboxylate and coupling it with SPDP N-succinimidyl 3-(2-pyridyldithio)propionate-modified LysPE38QQR. The resulting immunotoxin K1-LysPE38QQR was highly toxic to A431-K5 cells (a human epidermoid carcinoma cell line transfected with a mesothelin expression plasmid) with a half-maximal inhibitory concentration of 3-6 ng/mL. The immunotoxin had negligible activity against A431 cells, which do not express mesothelin (median inhibitory concentration > 100 ng/mL). This immunotoxin also caused complete regression of tumors in nude mice that received xenografts of mesothelin-positive human carcinomas. These results show that immunotoxins directed against mesothelin are a therapeutic option that merits further investigation for the treatment of ovarian cancer and malignant mesotheliomas.

Correlation between toxic natures of pyrethroid and behavioral response of desert locusts

Optomotor normal visual response of the locust Schistocerca gregaria was compared when injected (between 1st and 2nd thoracic segments) with 10, 5, 2.5 and 1.25 microg/g body weight doses of Permethrin after different intervals of time (just after injection, 10 and 20 minutes). LD50 value for Permethrin was calculated to be 3.0 microg/g. Results are analyzed statistically by t. test and ANOVA technique. It was noticed that there was a significant decrease of vision (P<0.005, Table II) in treated locusts and at the same time Permethrine effect is significantly time related (P<0.05, ANOVA, table III). Correlation between increasing age, weight and increasing toxicity has also been established. The inhibition of neural enzyme Cholinesterase with Permethrin and as a result more accumulation of acetylcholine at nerve junctions and less passage of the transmission of impulses thus less response from the locusts has also been explored and discussed.

111Indium-labeled monoclonal antibody K1: biodistribution study in nude mice bearing a human carcinoma xenograft expressing mesothelin

The monoclonal antibody (MAb) K1 is a murine IgG1 that recognizes mesothelin, a differentiation antigen present on mesothelium which is highly expressed on cancers derived from mesothelium, including most ovarian cancers and epithelioid mesotheliomas. MAb K1 was conjugated to 2-(p-isothiocyanatobenzyl)-cyclohexyl- diethylenetriaminepentaacetic acid and labeled with 111In. The biodistribution of 111In-K1 was studied in athymic nude mice bearing 2 s.c. tumors, one expressing a stably transfected plasmid encoding mesothelin and one composed of the parental untransfected A431 epidermoid carcinoma cells which do not express mesothelin. Tumor-bearing mice were given an i.v. injection of 111In-K1 and killed at different time points to determine the uptake of radiolabeled antibody. Significantly higher uptake was seen in antigen-positive tumors at all time points, with peak values at 72 hr (52.9% vs. 8% of the injected dose/g tissue for antigen-positive and antigen-negative tumors, respectively). Uptake in antigen-positive tumors was higher than the blood level at all time points, and the tumors contained a high level of the radiolabeled MAb even at 7 days (28.6% of the injected dose/g tumor).

The 'easy street' myth: self harm among aboriginal and non-aboriginal female sole parents in urban state housing

OBJECTIVE

To test the hypothesis that, controlling for socio-demographic factors, destructive behaviour among Aboriginal and non-Aboriginal female sole parents will not be significantly different.

METHOD

This study took place among an urban population of sole parents in Adelaide, South Australia, living in government housing. Two sample subsets were made up of 52 Aboriginal and 45 non-Aboriginal mothers from similar postcodes. Trained interviewers administered a questionnaire which, in addition to basic demographic data, elicited information concerning finance, housing, upbringing, experience of abuse and police interaction. The major issue of concern in the study was suicide attempt.

RESULTS

1-in-3 of the whole sample, 2-in-5 of the non-Aboriginal and 1-in-4 of the Aboriginal subset had attempted suicide at least once and half more than once. Statistical differences among 'attempters' vs. 'non-attempters', irrespective of ethnicity, included increased familial alcohol abuse, physical and sexual abuse, economic difficulty, poor self esteem and perceived discriminatory treatment by welfare agencies and, in the case of Aboriginals, by police.

CONCLUSION

The social environment is critical to understanding destructive behaviour, including self-harm, regardless of culture or ethnicity. The data show that suicide attempts among female sole parents in State-housing is one of the few health indices for which Aboriginal statistics are less than for non-Aboriginals.

IMPLICATIONS

It is evident that class, rather than ethnicity, better explains self-harm in this urban population. It is suggested that reluctance to access services, especially in times of crisis, relates in part to perceptions of care services and that, for Aboriginals, the value of culturally appropriate community-run services have specific public health and policy implications.

Treatment of mediastinitis: early modified Robicsek closure and pectoralis major advancement flaps

BACKGROUND

The treatment of sternal wound complications is controversial. It is our practice to combine early aggressive debridement, a modified Robicsek sternal closure, and bilateral pectoralis major advancement flaps with or without closed irrigation in a single procedure. We reviewed our experience to determine the efficacy of this approach.

METHODS

Grade II to IV mediastinitis (dehiscence and infection) developed in 47 patients 3 to 14 days after routine open heart operations between 1990 and 1995. Culture-positive infection was identified in 60% (n = 28); 62% (n = 29) had septicemia. Thirty patients underwent incision, drainage, and surgical assessment of the wound. Once systemic signs of infection were under control (no pyrexia, normal white blood cell count), formal single-stage debridement of all infected soft tissues and bones was performed. Sternal stability was achieved using a modified Robicsek closure and bilateral pectoralis major advancement flaps. Seventeen patients were treated with staged procedures.

RESULTS

Early sternal closure and coverage with pectoralis major advancement flaps can be associated with a low mortality (0%), low morbidity (13%; n = 4: three superficial wound infections, one seroma), and shortened hospital stay (median, 22 days, compared with a median of 82 days in patients managed with conservative staged treatment; p < 0.05). Sternal stability with excellent functional and aesthetic results has been achieved in all patients.

CONCLUSIONS

The combination of aggressive early surgical debridement, sternal closure, and the placement of bilateral pectoralis major advancement flaps is a simple procedure associated with a low mortality and morbidity and a short hospital stay.

Residential Choices of Immigrants in Australia

"In recent years Asian-Australians, especially those born in Indochina, have become a target of criticism by anti-immigration groups which accuse them of choosing to live only in ¿closed societies' and ¿ethnic ghettos' in Australian cities.... Evidence presented in the article shows clearly that while immigrant groups may prefer to settle in close proximity of their family and kin for practical and/or emotional reasons, their preference is not ethnically determined.... We also show that affordability, closeness to spouse's work, and neighbourhood services, rather than family and social contacts, are important factors for Asian-born immigrants when they move." (SUMMARY IN FRE AND SPA)

Effects of newspaper stories on the incidence of suicide in Australia: a research note

This study investigates the impact of newspaper stories on the incidence of suicide in Australia. The effects of suicide stories appearing in two major metropolitan newspapers between 1.1.1981 and 31.12.1990 were examined. The findings show that the daily average suicide rate in Australia increases significantly after the publication and publicity of suicide stories in the Australian media; the rise tends to be primarily due to the increase in male suicide and not female suicide. Some plausible explanations of this finding are advanced.

Fractures in childhood in Khartoum

A prospective study of fractures in 231 children received at Khartoum North Teaching Hospital(KNTH) was carried out for a period of six months. The incidence of child fracture rated as one per day, then it increased from the age of 5 years onwards in boys and between 6 and 8 years in girls. Most injuries were sustained during the day time, especially between late afternoon and sunset. 82% of injured children presented to a medical facility, while 18% were taken to native healers first. Non-road traffic accidents accounted for 84% of the fractures mainly due to sports, domestic injuries and falls; whereas road traffic accidents were 16% and occurred mainly in pedestrians. Forty three percent of the fractures needed only first aid and splintage while 42% needed closed reduction. Thirty one percent of all patients were treated as inpatients. The long bones were affected in 91% of all fractures, the commonest site being the distal end of the forearm (26%), followed by supracondylar fracture of the humerus (15.6%). In the upper limb, left-sided fractures predominated. The epiphyseal injuries were 3.5% of all fractures, mainly at the distal radial epiphysis. Boys were commonly affected between 13-15 years of age. Open fractures constituted 9.8% of the series and were mainly due to traffic accidents in town dwellers, the most vulnerable bones were those of the leg and foot. Pathological fractures accounted for 2.2% and were due to bone cysts and osteogenesis imperfecta. The problem of child safety and the preventive measures need to be more stressed.

Late-life-onset panic disorder: clinical and demographic characteristics of a patient sample

Although panic disorder is generally believed to begin in young adulthood, 13 cases of panic disorder with an initial onset after age 60 years have recently been seen at our clinics. Other than the time of life in which the first panic attack occurred, clinical and demographic profiles of these 13 patients were similar to those that have been reported for panic disorder patients whose panic began earlier in life. These findings indicate that panic disorder can affect older adults with no previous history of panic attacks, but further research is needed to determine the clinical and theoretical significance of late-life-onset panic disorder.

Management of death, dying and euthanasia: attitudes and practices of medical practitioners in South Australia

This article presents the first results of a study of the decisions made by health professionals in South Australia concerning the management of death, dying, and euthanasia, and focuses on the findings concerning the attitudes and practices of medical practitioners. Mail-back, self-administered questionnaires were posted in August 1991 to a ten per cent sample of 494 medical practitioners in South Australia randomly selected from the list published by the Medical Board of South Australia. A total response rate of 68 per cent was obtained, 60 per cent of which (298) were usable returns. It was found that forty-seven per cent had received requests from patients to hasten their deaths. Nineteen per cent had taken active steps which had brought about the death of a patient. Sixty-eight per cent thought that guidelines for withholding and withdrawal of treatment should be established. Forty-five per cent were in favour of legalisation of active euthanasia under certain circumstances.

Nurses and the management of death, dying and euthanasia

This article is one of two which report findings of research which examined the attitudes and practices of health professionals in South Australia towards the management of death, dying and euthanasia. The focus in this article is on findings related to nurses. Conducted in August 1991, mail-back, self-administered questionnaires were posted to a sample of 500 nurses on the general nurses register held by the Nurses Board of South Australia. A total response rate of 57.8% was obtained, and 55% (278) were usable returns. The survey found that 47% of the respondents had received requests from patients to hasten their deaths by withdrawing treatment, and 30% had received request from patients for active euthanasia. 'Persistent and irrelievable pain' was the main reason for such requests. The majority either would or did discuss such requests with relatives, other medical practitioners and nursing staff. Nineteen per cent had taken active steps which had brought about the death of a patient. Eighty-two per cent thought that guidelines for withholding and withdrawal of treatment should be established. Sixty per cent were in favour of legalization of active euthanasia under certain circumstances.

Cochlear implants and otitis media: considerations in two cleft palate patients

Cochlear implantation is a safe and effective means of rehabilitating profound sensory deafness. The implications of coincident chronic middle ear disease upon the operative procedure and auditory results have received little attention in the literature. We describe two patients, each with congenital cleft lip and palate and secondary chronic otitis media with effusion, who received multichannel cochlear implants following bacterial meningitis. One patient (a three-year-old girl) was implanted in the standard fashion while the other (a 38-year-old-man) underwent middle ear and mastoid obliteration. Our findings suggest that chronic otitis media should not be a deterrent to cochlear implantation.

Nephrotic-range proteinuria associated with right atrial myxoma

A case of right atrial myxoma presenting with right heart failure and proteinuria is described. Proteinuria was variable and this corresponded with the degree of systemic venous congestion. On one occasion the proteinuria was within the nephrotic range. There was no evidence of intrinsic renal pathology. The right heart failure and proteinuria resolved after tumour removal, suggesting that the etiology of urinary protein loss was a reversible increase in glomerular permeability.

A double-blind comparison of the effects of temazepam and triazolam on residual, daytime performance in elderly insomniacs

Benzodiazepine hypnotic medications are widely prescribed for elderly patients, but there is a paucity of information available concerning the residual cognitive and psychomotor (the morning-after) effects of these drugs. We compared two commonly used hypnotics--temazepam and triazolam--in a double-blind, placebo-controlled, single-dose study with community-dwelling healthy elderly with a DSM-III-R diagnosis of primary insomnia. Forty-five subjects over the age of 65 (mean age 72.23, SD = 4.44) qualified for the study. Subjects were randomly assigned to one of five treatment groups (placebo, triazolam 0.125 mg., triazolam 0.25 mg., temazepam 15 mg., and temazepam 30 mg.). Neuropsychological testing was completed at baseline and 12-14 hours after the dosing. Patients were evaluated with a variety of tests that measured attention, concentration, motor speed, immediate memory, and learning of new information. Separate repeated measured analyses of variance were performed to assess the significant changes among the five treatment groups. We found improved performance or no change in all the measures for all medication groups except for impairment of performance on a serial learning task for both high-dose medication groups. The significance of these results and the need for further research in elderly insomniacs is discussed.

Effectiveness of an intensive speech perception training program for adult cochlear implant recipients

A staggered multiple baseline single-subject experimental design was used to assess the effectiveness of a postimplant intensive aural rehabilitation program. Four adults with an acquired profound hearing loss were provided with a Nucleus 22-channel cochlear implant. The subjects completed a speech perception test protocol once before their cochlear implant operation and at 3-month intervals for a period of 12 months postimplantation. Each subject participated in a 12-week postimplant intensive aural rehabilitation program. A comparison of the prerehabilitation and postrehabilitation results failed to reveal any systematic improvements in performance on the speech perception tests that could be attributed unequivocally to the aural rehabilitation program.

Effect of thiamine on glucose utilization in hepatic cirrhosis

Thiamine, an essential co-enzyme, improves glucose utilization. Thiamine hydrochloride (50 mg per capita per day for 30 days), given to 25 patients with liver cirrhosis who had hyperglycaemia, produced a significant reduction (P less than 0.001) in blood glucose levels. It is therefore suggested that thiamine supplements be given to cirrhotics with hyperglycaemia, to improve glucose utilization.

Hepatotoxicity to different antituberculosis drug combinations

Hepatotoxicity to different combinations of anti-tuberculosis drugs containing, Rifampicin (R), Streptomycin (S), Isoniazid (H), Pyrazinamide (Z) and Myambutol (E) is described in 47 patients who completed 6 to 9 months therapy. Seven cases (15%) showed signs of toxicity and in 4 patients (8.5%) the drugs had to be withdrawn. Two patients developed hepatitis, one with jaundice and the other with fever and deranged liver functions, while others 2 developed severe hypersensitivity reactions. Burning palms, difficulty in micturition, itching and giddiness were complained of by one patient each, which settled in due course without recourse to withdrawal of drugs.