A multicenter study of the prevalence and susceptibility patterns of isolates of Streptococcus pneumoniae with reduced susceptibility to penicillin G in Louisiana

Because of increasing reports of multiple-antibiotic-resistant strains of Streptococcus pneumoniae and associated clinical failures, this study was performed to determine the prevalence of multiresistance among strains from nine Louisiana medical centers. Using a National Committee for Laboratory Standards broth microdilution method, 481 strains were tested. Of these, 70% were penicillin-susceptible (PS), 23% had intermediate minimum inhibitory concentration values to penicillin (I), and 7% were fully resistant to penicillin (PR). The isolation rates (15% to 40% for I strains and 0% to 33% for PR strains) at the various medical centers varied appreciably. The prevalence of penicillin resistance was highest among upper respiratory isolates, while cross-resistance to other antimicrobials varied. The least cross-resistance was noted among PS strains. However, strains with reduced penicillin susceptibility had high levels of cross-resistance. Among I strains, the prevalence of cross-resistance (%) was noted for amoxicillin/clavulanate (6%), cefuroxime (71%), cefaclor (91%), ceftriaxone (13%), cefotaxime (34%), erythromycin (67%), azithromycin (32%), and clarithromycin (32%). For PR strains, the prevalence of cross-resistance was 97% for amoxicillin/clavulanate, cefuroxime, and cefaclor; 67% for ceftriaxone and erythromycin; 89% for cefotaxime; and 69% for azithromycin and clarithromycin. These data emphasize the high prevalence of multiple-antimicrobial-resistance among strains of S pneumoniae with reduced penicillin susceptibility in this geographic area.

Detection of genital human papillomavirus and associated cytological abnormalities among college women

BACKGROUND AND OBJECTIVES

Human papillomavirus (HPV) is strongly implicated in the etiology of cervical neoplasia; however, the frequency, rate, and predictors of neoplastic progression are unknown.

GOAL

To measure the type-specific prevalence of cervical HPV and the rate of development of cytological abnormalities among a cohort of college women and to elucidate factors associated with acquisition of HPV DNA and progression to cytological abnormalities.

STUDY DESIGN

Women 18 to 40 years of age seeking routine gynecologic care at a university health center were enrolled in a cross-sectional study with prospective, longitudinal follow-up of a subset of women. Demographic and behavioral data were collected using a written questionnaire. HPV DNA was detected in cervical scrapes by polymerase chain reaction using L1 consensus primers and a generic and 25 type-specific probes, and cervical cytological abnormalities were identified by Papanicolaou's (Pap) smear.

RESULTS

HPV DNA was detected in 35% of the 414 women in the cross-sectional study; 66% of infections were with intermediate or high cancer risk HPV types. Multiple lifetime sex partners was an independent predictor of prevalent infection. Longitudinal analysis of 205 women showed that detection was transient (HPV DNA absent at follow-up) in 38% of the 84 women who were HPV-positive at enrollment. Persistent detection of the same HPV type at > or = 2 visits occurred in 14% of women and was significantly more common when intermediate or high cancer risk types were present. After 16 months of observation, 9% of HPV-infected women developed low-grade squamous intraepithelial lesions (SIL) and 5% developed high-grade SIL; the risk of incident SIL was 7.8-fold higher among women who had persistent HPV detection with the same type.

CONCLUSIONS

It was concluded that cervical HPV infection is highly prevalent among college women. Although most infections are caused by intermediate of high cancer risk types, few women (5%) developed high-grade SIL during 16 months of observation.

Differential induction of apoptosis by fludarabine monophosphate in leukemic B and normal T cells in chronic lymphocytic leukemia

Fludarabine (F-ara-A), an adenine nucleoside analog with efficacy in B-cell chronic lymphocytic leukemia (B-CLL), has also been shown to have a long-lasting suppressive effect on T lymphocytes. In heterogeneous clinical samples, apoptosis cannot be detected by standard methods in small cellular subsets. We developed, therefore, a combined assay of in situ end-labeling of nicked DNA by terminal deoxynucleotide transferase, with measurements of cellular DNA content and surface antigens (CD3, CD4, CD8, and CD19) by multiparametric flow cytometry. This assay was used to determine F-ara-A-induced apoptosis in different lymphocyte subsets from CLL patients and normal controls treated with F-ara-A in vitro. Apoptosis was also correlated to bcl-2 protein levels. We observed a direct effect of F-ara-A on both B-CLL and T lymphocytes. The response to F-ara-A in B-CLL lymphocytes in vitro was Rai stage-dependent, the early-stages being more responsive (P = .01). Higher levels of spontaneous apoptosis were observed in B-CLL lymphocytes from early stage patients (P = .02). No difference was observed in spontaneous apoptosis of normal T cells in B-CLL, although T lymphocytes in late-stage disease were more sensitive to F-ara-A-induced apoptosis. Incubation with cyclosporin A did not affect B-CLL and T-lymphocyte survival compared with control cultures. Results suggested a direct apoptotic effect of F-ara-A on B-CLL lymphocytes that decreases with increasing clinical stage. No correlation was found between bcl-2 and spontaneous or F-ara-A-induced apoptosis. Apoptosis occurred at all cell-cycle stages and was not restricted to cells in S phase. The mechanisms of this stage-dependent apoptosis in CLL remain to be elucidated.

Domestic violence: examining nurses' and doctors' management, attitudes and knowledge in an accident and emergency setting

Despite the increasing awareness of the important role that Accident and Emergency (A&E) personnel have in the diagnosis and management of domestic violence victims, there is limited knowledge about the nurses' or doctors' knowledge of or attitudes to domestic violence in Australian health care settings. In addition nursing and medical staff still receive very little training in working with domestic violence victims. This study was conducted to examine the existing knowledge, attitudes to and management strategies for domestic violence victims among 111 nurses and doctors in two rural and two country hospitals. The findings indicate that A&E staff recognise the importance of their role in the identification and management of domestic violence victims. Despite this they do not have all the skills necessary to deal effectively with the problem or to be able to access local resources for assistance. Education programs should focus on direct questioning techniques, and recognition of risk factors and protocols to provide guidelines for police involvement.

Trends in the incidence of upper extremity soft tissue malignancies: a 40-year review of the Connecticut State Tumor Registry

BACKGROUND

Although soft tissue malignancies of the upper extremity are rare, the management of these lesions has been controversial and the etiologic factors associated with the occurrence of these tumors are not well understood. The purpose of this study was to identify possible epidemiologic factors related to a recently noted rise in the occurrence of these tumors in the state of Connecticut.

METHODS

The occurrence of upper extremity soft tissue tumors over the past 40 years was reviewed in the Connecticut State Tumor Registry. Demographic data collected included occupational history, residence, and presence of concomitant malignancies. Tumor histology, the extent of resection, and the incidence of recurrences were also noted. Factors associated with recurrence were identified using linear regression analysis.

RESULTS

During the 40-year study period, 359 patients having upper extremity soft tissue tumors were entered into the Connecticut State Tumor Registry. An increasing trend in the number of upper extremity soft tissue tumors was evident. Many patients were involved in heavy industry or related fields. Fibrosarcoma and liposarcoma were the most common tumor types, occurring in 111 (30.3%) and 48 patients (13.2%), respectively. Sixty-seven patients presented with a synchronous second primary malignancy of the breast (49 patients), lung (seven patients), or gastrointestinal tract (five patients). Most patients (69.9%) underwent local excision of the soft tissue tumors, with fewer undergoing wide excision (20.3%) or radical excision (9.7%). Recurrence, which occurred in 144 patients, was found to be associated with extent of resection, occupational history, and concomitant malignancy. Delineation of such risk factors may be helpful in identifying patients in whom aggressive management may decrease recurrence and improve survival.

Food habits of young and middle-aged women living outside the capital cities of Australia

Young (18-22 years) and middle-aged (45-49 years) women living in urban and rural areas of New South Wales completed a brief food frequency questionnaire as part of a wider health survey. Urban women in both age groups consumed meat less frequently than women in rural areas, and women in the less populated rural areas were more likely to eat green and yellow vegetables and least likely to eat dried beans. There were few other geographic differences in food habits. Middle-aged women consumed reduced-fat milk, fruit, vegetables, fish, biscuits and cakes significantly more frequently, and rice, pasta, full-cream milk, fried food and take-away food less frequently than younger women. Smokers in both age groups consumed fresh fruit, vegetables and breakfast cereals significantly less frequently than non-smokers, and women with low levels of habitual physical activity consumed fresh fruit and cereals less frequently than more active women. The findings suggest that strategies aimed at changing eating behaviours should be age-group-specific and targeted specifically to smokers and less active women.

Human mini-chromosomes in mouse embryonal stem cells

We have introduced human mini-chromosomes of 4 Mb and approximately 15 Mb in size into mouse embryonal stem cells. Although these human mini-chromosomes are stable in hamster and chicken cells, they re-arrange or segregate aberrantly in the embryonal stem cells and are rapidly lost in the absence of selection. However, one of the mini-chromosomes re-arranged, acquired mouse centromeric sequences and was then stably maintained for at least 60 population doublings in culture. This mini-chromosome, which is 4 Mb in size, is a candidate for a mouse germ line chromosome vector.

Microbial production of a novel trihydroxy unsaturated fatty acid from linoleic acid

A bacterium isolated from a dry soil sample collected from McCalla, AL, USA, converted linoleic acid to a novel compound, 12,13,17-trihydroxy-9 (Z)-octadecenoic acid (THOA). The organism is a Gram-positive, non-motile rod (0.5 microns x 2 microns). It was identified as a species of Clavibacter ALA2. The product was purified by high pressure liquid chromatography, and its structure was determined by 1H and 13C nuclear magnetic resonance and Fourier transform infrared spectroscopies, and by mass spectrometer. Maximum production of THOA with 25% conversion of the substrate was reached after 5-6 days of reaction. THOA was not further metabolized by strain ALA2. This is the first report of a 12,13,17-trihydroxy unsaturated fatty acid and its production by microbial transformation. Some dihydroxy intermediates were also detected. THOA has a structure similar to those of known plant self-defense substances.

An in vitro model to assess mucosal immune function and bacterial translocation

The importance of secretory immunoglobulin A (IgA) on intestinal barrier function has gained increasing acceptance. However, due to the complexity of the intestinal microenvironment, the relative role of secretory IgA (sIgA) in mucosal defense has been difficult to study in vivo. Polarized Madin-Darby canine kidney (MDCK) epithelial cells expressing the complementary DNA (cDNA) for the polymeric Ig receptor were grown as monolayers in an in vitro two-chamber cell culture system to study the impact of sIgA on bacterial translocation (BT). Polymeric sIgA or media alone was added to the apical chambers of cell monolayers followed by apical inoculation with bacteria. The basal compartment was sampled at timed intervals thereafter to determine BT. Bacterial passage across the MDCK epithelial cell monolayers occurred in a time and bacterial inoculum concentration gradient. Addition of sIgA led to significant reductions in BT across the epithelial cell monolayers. This is a useful model for further investigation on the role of sIgA in intestinal barrier function.

A comparison study of children with sickle cell disease and their non-diseased siblings on hopelessness, depression, and perceived competence

The purpose of this comparison study was to explore the extent to which hopelessness and self-perceptions of competence are associated with depression in a community population of children with sickle cell disease compared to their non-diseased siblings. Subjects were African-American children drawn randomly from the case management programme at the L.D. Barksdale Sickle Cell Anemia Foundation. Depression scores were higher for the non-diseased siblings. The children with sickle cell disease scored lower on the perceived physical competence scale. Recommendations for practice include increasing hope, improving relationships, monitoring depression in patients and their siblings, and monitoring perceptions of cognitive, social, physical, and general self-worth.

Ownership and uses of human tissue: does the Nuffield bioethics report accord with opinion of surgical inpatients?

OBJECTIVE

To compare opinion of surgical inpatients with the conclusions of the report of the Nuffield Council on Bioethics regarding the ownership and uses of human tissue.

DESIGN

Survey of results of questionnaires completed by patients.

SETTING

Large teaching hospital.

SUBJECTS

384 postoperative adult surgical patients.

RESULTS

There was strong support among patients for the use of tissues in medical education, research, and science with the exception of those tissues which may transmit disease to others. Few patients (39; 10%) believed that they retained ownership of tissue removed at surgery. Most believed that the tissue belonged to the hospital (103; 27%), to nobody (103; 27%), or to the laboratory (77; 20%). Most patients had not been given any information about the possible uses of their tissues after removal.

CONCLUSIONS

Surgical inpatients seem to endorse the conclusions of the Nuffield report regarding the ownership and uses of human tissue. The recommendations regarding patient information and consent procedures should be implemented at the earliest opportunity.

Mammalian artificial chromosomes

The development of candidate vectors and of techniques for their manipulation by sequence targeting suggest that a mini-chromosome vector system for the mouse germline may be at hand. Mini-chromosome vectors should allow new sorts of genetic problems to be addressed experimentally and may accelerate the process of gene identification.

Production of an extracellular polysaccharide by Agrobacterium sp DS3 NRRL B-14297 isolated from soil

A bacterium isolated from soil and identified as Agrobacterium sp produced a water-soluble extracellular polysaccharide capable of producing highly viscous solutions. Gas chromatographic analysis revealed a sugar composition of glucose, galactose and mannose in the molar ratio of 7.5:2.4:1, together with 3.7% (w/w) pyruvic acid. Methylation analyses showed the presence of (1-->3)-, (1-->4)- and (1-->6)-linked glucose, (1-->3)- and (1-->4, 1-->6)-linked galactose and a small portion of (1-->3)-linked mannose residues. Succinic acid was not present. The molecular weight of the polysaccharide was estimated by light scattering to be 2 x 10(6) Da. The viscosity of solutions containing the polysaccharide remained constant from pH 3 to 11, and decreased by 50% when heated from 5 to 55 degrees C. Maximum yield of the polysaccharide, 20 g L-1, was reached in 48 h at 30 degrees C incubation.

Midfoot fractures

Midfoot fractures, which include injuries to the tarsal navicular, cunieforms, and the cuboid, are uncommonly detected. Prompt diagnosis and appropriate treatment of these fractures are essential for maintaining normal foot biomechanical function. This article reviews various midfoot fractures.

Domestic violence experienced by women attending an accident and emergency department

The aim of the study was to establish the extent and severity of domestic violence experienced by women attending the accident and emergency department of a large teaching hospital in Newcastle. The data were collected over a five-week period in 1992. All women between 17 and 80 years, attending the emergency or ambulatory areas between 8 a.m. and midnight, were asked to complete a confidential structured interview. A total of 401 women participated in the study, representing 82 per cent of eligible women approached. Each participant was asked if she had ever been physically hurt by someone close to her. Questions were asked to determine the relationship to the perpetrator, the type and cause of injury, treatment necessary and help sought. Seven (1.7 per cent, 95 per cent confidence interval (CI) 0.46 to 3.02) of the women surveyed were attending the hospital as a direct result of an incident of domestic violence, and 100 women (25 per cent, CI 21 to 29) had experienced domestic violence at some time. Bruising, fractures and cuts were the most common forms of injury, with the most common locations being the head, face and chest. Weapons, such as guns and knives, were used in 20 per cent of the incidents. A considerable number of the women (68 per cent) did not seek help at the time of their injuries. As a substantial proportion of women have experienced domestic violence in their lives, accident and emergency workers should receive training in recognising and assisting victims of domestic violence.

Bacteriology of urinary tract stones

It has been reported that up to half of renal stones and associated urine specimens have been positive on culture, and that up to 50% of such stones contain magnesium ammonium phosphate. In a prospective study using infrared and wet chemical analysis, we found positive cultures in only 7 of 132 renal, 5 of 105 ureteral and 6 of 21 bladder stones obtained surgically and handled with sterility. Of the culture positive calculi only 43% from the kidney, none from the ureter and 50% from the bladder contained detectable magnesium ammonium phosphate. However, magnesium ammonium phosphate was detectable in 20% of renal, 2% of ureteral and 27% of bladder stones with negative cultures. Of the culture positive renal and ureteral calculi 42% were predominantly calcium phosphate and 17% were predominantly calcium oxalate. For culture negative stones 25% and 51% from the kidney, and 15% and 82% from the ureter were composed of predominantly calcium phosphate and calcium oxalate, respectively. Among the culture positive stones, related positive urine cultures were noted in 100% of the renal, 20% of the ureteral and 50% of the bladder cases, compared to 26%, 10% and 27%, respectively, of culture negative calculi. The same organism was found in the stone and urine in only 38% of the cases. The lower frequency of positive urine cultures, of stones with magnesium ammonium phosphate, and especially of culture positive renal and ureteral stones (5%) than in previous reports suggests that stone culture may be of less value than indicated previously, except for bladder calculi and large renal stones, such as the branched type.

Treatment for mental illness and substance abuse in a public psychiatric hospital. Successful strategies and challenging problems

Although the literature on dual diagnosis has grown considerably over the last several years, report describing inpatient treatment models are less common. We describe some of the major treatment concerns in the dural diagnosis literature, such as using 12-step self-help programs like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), dealing with different stages of treatment, and developing a program with integrated substance abuse and psychiatric treatment. The practical application of these treatment issues is featured by showing how they are incorporated into an innovative inpatient dual diagnosis treatment program at a public psychiatric hospital. Finally, the treatment program is described in detail regarding administrative issues, staff training, daily treatment schedules, and patient demographics.

Children with a schizophrenic disorder: neurobehavioral studies

This paper summarizes retrospective and cross-sectional neurobehavioral studies of schizophrenic children. Retrospective studies of schizophrenic children reveal that during early childhood, prior to the first onset of schizophrenic symptoms, most schizophrenic children showed delays in language acquisition and/or impairments and delays in visual-motor coordination. These impairments appear to be developmental delays rather than fixed neurobehavioral impairments, because cross-sectional studies conducted when the children are at least 10 years of age, after the first onset of psychosis, fail to detect the same deficits. The results of behavioral, cognitive/neuropsychological studies as well as the study of event-related potentials measured during performance of cognitive tasks suggests that schizophrenic children suffer from limitations in processing resources. It is argued that the developmental delays observed in schizophrenic children represent the greater time it takes them to automate certain skills. The delay in automation may reflect their limited information-processing capacity.

Endogenous serum antibodies that interfere with a common thyroid hormone uptake assay: characterization and prevalence

We identified individuals whose serum contained a substance that produced falsely decreased thyroid hormone (T)-uptake values determined by the Emit (Syva) procedure. Investigation of this interference was prompted by identification of a patient with T-uptake values inconsistent with clinical assessment. IgG depletion and supplementation studies with this patient's serum suggested that the interference was due to endogenous antibodies with specificity for the thyroxine-glucose-6-phosphate dehydrogenase conjugate in the Emit T-uptake assay. The prevalence of the interference was examined by prospectively comparing routine Emit T-uptake values of 1710 patients' samples to T-uptake values obtained by another method. Discrepant samples were also assayed by a radioactive binding triiodothyronine-uptake assay. We identified eight samples that had falsely decreased T-uptake values by Emit, for an overall prevalence of 0.46%. Among 45 consecutive patients with a T-uptake value < 20%, five patients, or 11%, were falsely decreased by Emit and three of these were clearly due to an interfering IgG. We suggest that samples with abnormally low T-uptake values determined by the Emit method be confirmed by an alternative method.

Endogenous serum antibodies that interfere with a common thyroid hormone uptake assay: characterization and prevalence

We identified individuals whose serum contained a substance that produced falsely decreased thyroid hormone (T)-uptake values determined by the Emit (Syva) procedure. Investigation of this interference was prompted by identification of a patient with T-uptake values inconsistent with clinical assessment. IgG depletion and supplementation studies with this patient's serum suggested that the interference was due to endogenous antibodies with specificity for the thyroxine-glucose-6-phosphate dehydrogenase conjugate in the Emit T-uptake assay. The prevalence of the interference was examined by prospectively comparing routine Emit T-uptake values of 1710 patients' samples to T-uptake values obtained by another method. Discrepant samples were also assayed by a radioactive binding triiodothyronine-uptake assay. We identified eight samples that had falsely decreased T-uptake values by Emit, for an overall prevalence of 0.46%. Among 45 consecutive patients with a T-uptake value < 20%, five patients, or 11%, were falsely decreased by Emit and three of these were clearly due to an interfering IgG. We suggest that samples with abnormally low T-uptake values determined by the Emit method be confirmed by an alternative method.

Self-discrepancies and perceived peer acceptance

We examined developmental changes in the self and the relationship between such changes and perceived peer acceptance in a sample of 414 6- to 11-year-old Australian children (211 boys, 203 girls) who completed a self-discrepancy scale and a perceived peer acceptance scale specifically constructed for this study. Resulting scores suggested that critical periods in developmental changes in the structure of the self occur at about 7 to 8 years and that a relationship exists between the reporting of a comparative large number and a larger size of discrepancies and a perception of lack of peer acceptance.

Transthoracic fine-needle aspiration biopsy cytology of pulmonary neoplasms

The experience with 212 transthoracic fine-needle aspiration biopsy cytology specimens of mass lesions of the lung at a small Canadian hospital is reviewed. The technique showed a sensitivity of 78.0%, a specificity of 85.7%, a positive predictive value of 98.5%, and a negative predictive value of 25.0% when the cytological diagnoses were compared with the final clinicopathological diagnoses listed in the patients' charts. There was only one false positive diagnosis of malignancy. Diagnoses based on cytology of the aspirates were compared with histological diagnoses in 127 cases and the accuracy of typing of the major groups of carcinoma was assessed. Distinction between small-cell carcinoma and non-small-cell carcinoma was usually accurate and fairly good correlation was achieved for all major types of carcinoma. The results for typing of the neoplasm are not as good as those from larger centres in the world. The technique is considered to be useful even in the setting of a small hospital.

Filipin and its interaction with cholesterol in aqueous media studied using static and dynamic light scattering

Aggregation of filipin in aqueous medium and filipin-induced changes in cholesterol micelles have been studied using intensity and dynamic light scattering. The dependencies of filipin aggregate dimensions on concentration, solvent, and temperature were studied, and revealed that the aggregates do not have a well-defined geometry, i.e., a critical micelle concentration cannot be detected and stable structures are not formed. The aggregates are of size Rg approximately 110 nm and Rh approximately 63 nm, referring to the radius of gyration and hydrodynamic radius, respectively. In the concentration range studied (1 microM < C < 30 microM), a low molecular weight species (monomer/dimer) is always present together with the aggregates. In ethanol/water mixtures, large (Rg approximately 500 nm), narrow distribution aggregates are formed in the water volume fraction range 0.45 < phi H2O < 0.65. Aggregation also occurs on changing the temperature; In the range 7-37 degrees C, smaller aggregates (10-30 nm form and the process is only partially reversible. No pronounced effect of filipin on the structure of the cholesterol micelles was observed (a small increase in Rg and Rh is noted). These results rule out any "specificity" for the filipin interactions with cholesterol, which has been considered a key event in the filipin biochemical mode of action. A reevaluation of this question is suggested and some alternatives are advanced.

Induction of systemic immunologic hyporesponsiveness to ovalbumin in neonatal rats by the enteric administration of peptic fragments of ovalbumin

The orogastric administration of protein antigens can induce specific systemic immunologic hyporesponsiveness to the antigens. Some evidence has suggested that fragmention of the antigens by proteolytic enzymes in the gastrointestinal tract is a necessary step in this phenomenon. We administered either ovalbumin (OVA) or fragments OVA, produced by digestion with pepsin, into the stomach or jejunum of suckling rats and measured the serum IgG antibody response to a subsequent intraperitoneal challenge with OVA. Whereas OVA administered by gastric gavage caused virtually a complete unresponsiveness to the OVA challenge, administration into the jejunum had no significant effect. Administration of peptic fragments of OVA (about 8000 Da) into either the jejunum or stomach caused systemic unresponsiveness in 62% and 67% of animals, respectively (p < .05 vs buffer-fed controls). Smaller fragments of OVA (< 2000 Da) given into the stomach or jejunum had no effect on systemic IgG responses, nor did administration of the 8000 Da fragments intraperitoneally. We conclude the 1) systemic immunologic tolerance to OVA can be induced by enteric administration of critical-size fragments of OVA, and 2) encounter of the OVA fragments, like intact OVA, via the gut yields a distinctly different response from that which follows parenteral administration.

Standardization of glycohemoglobin determinations in the clinical laboratory: three years of experience

Measurement of glycohemoglobin has been recommended for the long-term assessment of glycemic control in diabetic patients. Because different analytical methods measure different glycohemoglobin species, it has been difficult to compare results between laboratories. Here we report 3 years of experience with calibration of an affinity chromatography method for measuring total glycohemoglobin (GHb). Calibration was achieved by including in each assay three hemolysate calibrators for which values for HbA1c and GHb had been determined by repeated analyses by high-performance liquid chromatography (HPLC) and affinity chromatography, respectively. Calibration improved interassay precision (CV = 3.20-7.90% and < 5.0% before and after the introduction of calibration, respectively) and eliminated lot-to-lot variability. In 91 samples, HbA1c was estimated by the calibrated affinity chromatography assay and measured by an ion-exchange HPLC method. Estimated and HPLC-measured HbA1c showed no clinically significant differences during 36 months. The high degree of long-term precision, the disappearance of lot-to-lot variability, and the excellent comparability between analytical methods measuring different species of glycated hemoglobins demonstrate the advantages of calibration.

Standardization of Glycohemoglobin Determinations in the Clinical Laboratory: Three Years of Experience

Measurement of glycohemoglobin has been recommended for the long-term assessment of glycemic control in diabetic patients. Because different analytical methods measure different glycohemoglobin species, it has been difficult to compare results between laboratories. Here we report 3 years of experience with calibration of an affinity chromatography method for measuring total glycohemoglobin (GHb). Calibration was achieved by including in each assay three hemolysate calibrators for which values for HbA1c and GHb had been determined by repeated analyses by high-performance liquid chromatography (HPLC) and affinity chromatography, respectively. Calibration improved interassay precision (CV = 3.20-7.90% and &lt; 5.0% before and after the introduction of calibration, respectively) and eliminated lot-to-lot variability. In 91 samples, HbA1c was estimated by the calibrated affinity chromatography assay and measured by an ion-exchange HPLC method. Estimated and HPLC-measured HbA1c showed no clinically significant differences during 36 months. The high degree of long-term precision, the disappearance of lot-to-lot variability, and the excellent comparability between analytical methods measuring different species of glycated hemoglobins demonstrate the advantages of calibration.

Rod-like cholesterol micelles in aqueous solution studied using polarized and depolarized dynamic light scattering

Micelles of cholesterol in aqueous solution have been investigated using polarized and depolarized dynamic light scattering. They are shown to be highly extended and characterized by a narrow size distribution. It is shown that a rod-like model is applicable with length, L = 580 nm. Determination of the rotational diffusion coefficient by analysis of the autocorrelation function gave a value of theta = 150 s-1, which is close to the calculated value for the rod with this dimension. Depolarized dynamic light scattering measurements as a function of angle gave a value of 110 s-1.

Arteriovenous malformation of ureter

Congenital arteriovenous malformations of the genitourinary tract are rare. We report the first case of an arteriovenous malformation of the ureter. The patient presented with recurrent hematuria and left flank pain. Evaluation included an intravenous urogram, cystoscopy, and retrograde pyelography. A pedunculated lesion thought to be a fibroepithelial polyp was seen at the time of ureteroscopy, and the lesion treated by excisional biopsy and fulguration. Pathologic examination demonstrated an arteriovenous malformation. After thirty-month follow-up, the patient remains asymptomatic and free of recurrence.

Antibiotic-primed fibrin gel improves outcome in contaminated splenic injury

Fibrin gel (FG) has recently been shown to be bactericidal in the management of contaminated hepatic injury; antibiotic loading of fibrin gel (AFG) may augment this effect. We evaluated the antimicrobial properties of FG and AFG in a rat model of contaminated splenic injury. Fibrin gel was made from centrifuged plasma of separate donor rats and bovine thrombin. Antibiotic fibrin gel was similarly produced following intravenous injection of 70 mg/kg ticarcillin. Male Holtzman rats (250-300 g) were anesthetized and a laparotomy done. The abdomen was contaminated with 1 x 10(7) Bacteroides fragilis and the spleen transected in the midportion. Treatment consisted of splenorrhaphy (S) (n = 7), FG application (n = 7), or AFG (n = 7). The animals were autopsied at 1 week to evaluate abscess formation and abdominal adhesions (grade I = none, grade II = mild, grade III = severe). Antibiotic/fibrin gel significantly decreased abscess formation following splenic injury when compared with S (2 of 7 vs. 7 of 7; p less than 0.05 by ANOVA) without an increase in adhesions. Fibrin gel also decreased abscess formation but not significantly (4 of 7 vs. 7 of 7). Histologic analysis confirmed the beneficial effect of FG and AFG on wound healing. The bactericidal effect of FG is improved by antibiotic loading in contaminated intraabdominal injury.

Electrophysiologic changes in lumbar spinal cord after cervical cord injury

Spontaneous activity on the EMG examination is traditionally ascribed to disease of the lower motor neuron when present in muscles well below the level of para- or quadriplegia despite the absence of any detectable peripheral nerve injury. It is uncertain whether it reflects transient paralysis of transmission (related to clinical spinal shock) or irreversible postsynaptic damage. We performed serial EMG studies of lower extremities and paraspinal muscles on eight young, previously healthy adults, commencing 2 to 9 weeks after acute cervical cord injury. All had stimulated single-fiber EMG (SFEMG) studies at 6-month intervals to determine whether irreversible postsynaptic damage of the anterior horn cell had occurred. MRI and nerve conduction excluded patients with evidence of distal cord injury or peripheral neuropathy. All patients had spontaneous activity in all muscles tested, persisting after spinal shock had resolved. Jitter was present on SFEMG in three of eight patients 6 months after injury. Four of five patients retested 12 months after injury had abnormal jitter, including three who initially had normal SFEMG studies. We conclude that there is electrophysiologic evidence of trans-synaptic distal cord dysfunction following acute spinal cord injury. SFEMG studies suggest that anterior horn cell dropout occurs during the 1st year after injury.

Evolving models of family-centered services in neonatal intensive care

The article examines the evolution of models for providing family-centered services in neonatal intensive care settings. Child-focused, parent-infant interaction, and ecological models are presented and discussed. One specific ecological model, the family-centered care model, is examined in detail. While most current programs endorsed family-centered care (FCC) as a "best practice" for developmental intervention with infants, few were found that implemented these practices. Most utilized only limited components of FCC. Instead, programs operating in NICU settings had features directed toward child care, staff training, family support and transition to the community, rather than impacting the philosophy of care and/or service delivery system in the NICU. Suggestions for working toward FCC in NICU settings are given and barriers are discussed.

Cardiovascular implant calcification: a survey and update

Calcification of cardiovascular prosthetic implants is a common and important problem. This review provides an update based upon the Conference on Cardiovascular Implant Calcification held as part of the 13th World Congress of the International Society for Heart Research, 1989. A variety of cardiovascular prostheses are affected clinically by calcification, including bioprosthetic heart valves, aortic homografts and trileaflet polymeric valve prostheses. In addition, experimental studies have demonstrated calcification of artificial heart devices in ventricular assist systems in long-term calf studies. The pathophysiology of this disease process is incompletely understood. A common element between the various types of cardiovascular implant calcification is the localization of calcific deposits to devitalized cells and membranous debris. Prevention of cardiovascular implant calcification by either biomaterial modifications or regional drug therapy (controlled release) is being investigated.