Synthesis of 3-Methyl-4-oxo-3,4-dihydroquinazoline-5-sulfonamide and a Herbicidal Sulfonylurea Derivative

Starting with 6-chloroquinazolin-4(3H)-one (5), a convenient synthesis of 3-methyl-4-oxo-3,4-dihydroquinazoline-5-sulfonamide (11) has been achieved. The sulfonamide (11) was used to prepare a highly herbicidal sulfonylurea derivative (13).

A multidisciplinary team approach to day hospital patient care

A review of practice in a mental health day hospital led to a multidisciplinary quality group being established. Outlines changes implemented leading to service improvements and increases in patient and staff satisfaction.

Analysis of the contributions of herpes simplex virus type 1 membrane proteins to the induction of cell-cell fusion

The contributions of a set of herpes simplex virus type 1 membrane proteins towards the process of cell-cell fusion were examined with a series of deletion mutants into which a syncytial mutation had been introduced at codon 855 of the glycoprotein B (gB) gene. Analysis of the fusion phenotypes of these recombinant viruses in Vero cells revealed that while gC, gG, US5, and UL43 are dispensable for syncytium formation at both high and low multiplicities of infection, gD, gHgL, gE, gI, and gM were all required for the fusion of cellular membranes. These data confirm that the requirements for virion entry and cell-cell fusion are not identical. gD and gHgL, like gB, are essential for both processes. gG, gI, and gM, on the other hand, are dispensable for virus penetration, yet play a role in cell-to-cell spread by the direct contact route, at least on an SC16 gBANG background.

Interpractice visits by general practitioners

Most of the objectives have thus been successfully met as the interpractice visits have proven to be a well accepted form of self-regulated implicit peer review activity among GPs, continuing with enthusiasm on the part of the participants over a period of five years and now propagating nationally. Significant to the success is the ownership of the scheme by the participants. The advent of QA and CE credit points can only enhance participation rates. Continuing attention to the principles of audit, namely evaluation, change and review, will refine the method in the future into an even more effective tool, which can be recommended to all those in general practice. A necessary area for attention in the future is effective outcome evaluation.

Screening infants for neuroblastoma: the parents' perspective

Health visitors collected urine samples from 6-month-old infants in a feasibility study of infant screening for neuroblastoma. As part of the project's evaluation, a study was conducted of the parents' views and experiences of screening. Parents of the most recently screened infants were contacted: 85 (68% of those contacted) were interviewed. Despite intermittent media coverage and written and verbal information being available, parents' overall knowledge of neuroblastoma screening was poor. Thirteen percent reported that they did not know the purpose of the test. Approximately one-third of parents reported initial anxiety about the test. Where samples were repeated because of unsatisfactory results, this percentage increased to 41% for a first-repeat sample. Parents were willing to make considerable effort to provide samples for screening but worried unnecessarily because the information they were given was either inadequate or in an inappropriate format (ie, verbal instead of written).

An analysis of the in vitro and in vivo phenotypes of mutants of herpes simplex virus type 1 lacking glycoproteins gG, gE, gI or the putative gJ

Mutants of herpes simplex virus type 1 (HSV-1) lacking glycoproteins gG, gE, gI or the putative gJ were constructed by inserting a lacZ expression cassette within the US4, US8, US7 and US5 genes respectively. Revertant viruses were then constructed by rescue with a wild-type DNA fragment. Each of these mutant viruses, by comparison with the parental virus HSV-1 SC16, exhibited normal particle to infectivity ratios, and had no discernible phenotypic abnormalities in baby hamster kidney-21 cells following high or low multiplicity infections. Infection of mice by scarification of the ear with these mutant viruses showed the following. (i) Interruption of the US5 (gJ) gene has no effect on the ability of HSV-1 to multiply at the inoculation site or its ability to enter or multiply in the peripheral or central nervous system (CNS). This shows that the US5 gene provides a convenient site for the insertion of foreign genes for both in vitro and in vivo studies. (ii) Disruption of the US4 (gG) gene results in marginal attenuation in the mouse ear model. (iii) Disruption of the US7 (gI) or US8 (gE) genes results in pronounced attenuation; virus was rapidly cleared from the inoculation site and was barely detectable in sensory ganglia or in the CNS. The failure of gI-negative or gE-negative viruses to replicate efficiently at the inoculation site in vivo led to the investigation of virus behaviour in epithelial cells in vitro. Viruses lacking gE or gI adsorbed to and entered these cells at normal rates compared with the parental virus, but formed minute plaques. This is consistent with a failure of cell-to-cell spread by the cell contact route. This was confirmed by measurement of the rate of increase in infectious centre numbers following low multiplicity infections. The view that gE and gI influence interactions between cells at the plasma membrane was reinforced by showing that the introduction of disrupted gE or gI genes into a syncytial, but otherwise syngeneic, background resulted in a non-syncytial phenotype. We conclude that the gE-gI complex plays a part, at least in some cell types, in the interactions at the cell surface that allow transmission of the virus from infected to uninfected cells by cell contact. In syncytial strains this leads to uncontrolled membrane fusion.(ABSTRACT TRUNCATED AT 400 WORDS)

Implementing a research-based protocol: an interactive approach

Endotracheal suctioning (ETS) is a common procedure done in the critical care environment. There are many different practices related to ETS. With the proliferation of research studies about ETS, a change in practice is needed to incorporate these research findings. The authors present a creative teaching strategy that was used to implement a research-based ETS protocol.

Screening infants for neuroblastoma: the parents' perspective in false-positive cases

The objective of this study was to ascertain the reactions and experiences of parents whose children were defined as false-positive cases in a research program of screening 6-month-old babies for neuroblastoma. Parents of seven of the eight infants falling into this category participated in the study. Parents of five children described themselves as worried/very worried at the positive result, some contemplating the treatment involved and the possibility that their child could die. Parents waited a maximum of 3 days before the clinical investigations took place. The mother of one child was dissatisfied with the handling of the investigations, reporting a lack of information and little opportunity to discuss questions; she was subsequently more anxious about her child. Parents of two children reported lasting "concerns" that they attributed to neuroblastoma screening.

Identification of a gene from Xp21 with similarity to the tctex-1 gene of the murine t complex

Long range physical mapping within the p21 region of the X chromosome identified a CpG rich island approximately 180 kb centromeric to the chronic granulomatous disease (CGD) locus. The segments adjacent to the CpG island hybridized to discrete bands in DNAs of several species and when used to screen retinal cDNA libraries led to the identification of cDNAs that detected a mRNA of 2.1 kb in many tissues. Molecular characterization of corresponding genomic clones of this novel human gene confirmed the origin of the cDNA clones and indicated a genomic structure with five exons spanning a total of 9 kb. The complete cDNA sequence revealed that this gene contained a putative open reading frame of 116 amino acids with a 3' untranslated region of 1.74 kb. The amino acid sequence shows a high degree of similarity to the predicted product of the tctex-1 gene of the mouse t complex. As linkage studies and patients with deletions have implicated the Xp21 region as containing the retinitis pigmentosa defect (RP3), the gene was assessed as a candidate disease gene in RP3 families. A single base pair polymorphism was identified within the coding region but no disease associated changes were found by single strand conformational polymorphism and sequencing analysis of amplified exons of 20 RP patients. Analysis of a dinucleotide repeat polymorphism within this gene in families affected with RP3 suggested refinement of the RP3 region.

False positive results in a neuroblastoma screening programme

Twenty thousand, eight hundred and twenty-nine babies were screened for neuroblastoma at 6 months of age by measuring homovanillic (HVA) and vanillylmandelic (VMA) acid in urine and rationing these to creatinine. Using a "cut off" of the mean + 3 SD, 10 were found to be positive. Two were found on evaluation to have neuroblastoma and in the remaining 8 the raised levels of HVA and/or VMA returned to normal. Only one of the 8 false positive babies was absolutely normal, most having a chronic disorder or illness. Utilising new centiles which relate HVA and VMA to creatinine, only 3 of the 8 would have remained positive, a false positive rate of 0.01%. The false negative rate would have remained unchanged.

Assessment of nutritional status. The clinician's perspective

The prevalence of malnourished patients in the hospital continues to hover around 50%. As more ambulatory and day care medical and surgical facilities open, those actually admitted to the nation's acute care hospitals will be sicker, and thus a higher percentage will be malnourished. There is currently a plethora of tools designed to assess nutritional status within the spectrum of a broad range of costs and sensitivity. At the very least, upon admission to an acute care hospital, patients should undergo a nutritional screening consisting of weight history, recent dietary habits, and serum albumin concentration. An accurate assessment of the degree of malnutrition should rely on the expertise of a dietician trained to use the techniques of global nutritional assessment in conjunction with anthropometries. Clinical laboratories need to enlarge their services to encompass more direct measures of body composition (e.g., BIA) and dynamic assessment of muscle function (e.g., WOB). Subsequent serial measurements of nutritional status have limited sensitivity and specificity but may be useful in selected patients with a high severity of illness score (i.e., APACHE) and prolonged LOS. Attention should be directed to ensuring that nutrient intakes correspond to estimated needs.

Creatinine related reference ranges for urinary homovanillic acid and vanillylmandelic acid at 6 months of age

The relationship between homovanillic acid (HVA), vanillylmandelic acid (VMA), and creatinine in the urine of 6 month old babies has been studied and reference ranges in the form of centiles constructed for HVA and VMA against creatinine. Over 10,000 urine samples were collected from babies in four health districts in the north of England. HVA and VMA concentration, either independently or when divided by creatinine concentration, were dependent upon the absolute concentration of creatinine in the sample. After adjustment for creatinine significant differences in the mean concentration of HVA were found between sexes. No such differences were found for VMA. HVA and VMA were also found to be age dependent. Centiles were constructed using a procedure which makes no distributional assumptions about the data. The net effect of utilising these centiles was to increase the predictive value of a positive screening test from 20% to 40% without any increase in the false negative rate.

Screening for neuroblastoma in the north of England

OBJECTIVE

To determine the feasibility of establishing a system of screening for neuroblastoma.

DESIGN

Prospective study of mass screening in four clearly defined geographical areas.

SETTING

Four health districts of the Northern region of England.

SUBJECTS

20,829 babies aged 6 months, 92% of target population.

INTERVENTIONS

Collection of urine on filter paper for analysis of content of homovanillic and vanillylmandelic acid in relation to urinary creatinine concentrations.

MAIN OUTCOME MEASURES

Derivation of reference range. Identification of babies with homovanillic or vanillylmandelic acid > 3 SD above the mean (positive cases). Investigation of positive cases for evidence of neuroblastoma.

RESULTS

The upper limit of normal (3 SD above the mean) for vanillylmandelic acid was 15 mumol/mmol creatinine and for homovanillic acid 24 mumol/mmol creatinine. Of the 20,829 babies screened, 2537 (12.2%) required a second sample to be taken because the first sample was inadequate. Of these, 527 (2.5%) provided a liquid urine specimen and 10 (0.04%) had positive results for neuroblastoma. Two of them had neuroblastoma (true positives) and eight did not (false positives). A further three children from the cohort were subsequently found to have neuroblastoma; they had raised homovanillic acid or vanillylmandelic acid values, or both, but screened negative at 6 months.

CONCLUSIONS

Screening for neuroblastoma is possible in the health care system of the United Kingdom. Evaluation of the efficacy of screening in reducing the mortality from neuroblastoma requires a controlled trial.

A pilot study of screening for neuroblastoma in the north of England

A pilot study has been carried out to assess the feasibility of screening for neuroblastoma in 6-month-old infants in the north of England. A total of 20,829 infants were screened. Two true-positive cases were found, along with eight false-positive and three false-negative cases. It was shown that the concentrations of catecholamine metabolites in the urine are dependent on the creatinine content; centiles have been established to allow this relationship to be taken into account. Five of the eight false-positive cases would have been correctly assessed as normal if the new centiles had been used. Preliminary results lend support to the need for a well-designed study of neuroblastoma screening to be carried out, with death from this disease as the only end point.

Screening for neuroblastoma in the northern region of England. Laboratory aspects

Our pilot study for neuroblastoma screening started in 1986. The study has progressed through several phases, with use of several analytical methods to a procedure based primarily on the use of automated gas chromatography mass spectrometry. The northern region of England has a relatively static population of approximately 3.5 million, with an annual birth rate of 41,000. The region consists of 16 administrative health districts. In 4 years, we have screened 20,829 infants from four health districts. In this program, we screen all children at 6 months of age. A urine sample is collected on filter paper by a health visitor, either at the time of the infant's routine clinic visit or during the health visitor's follow-up visit at home. In the laboratory, the sample is dried and processed for analysis of homovanillic acid (HVA) and vanillylmandelic acid (VMA), using a benchtop Hewlett Packard gas chromatograph mass spectrometer. The results are related to the creatinine content of the urine. Using cut-off limits of 39 micrograms/mg of creatinine for HVA and 25 micrograms/mg of creatinine for VMA, 2,537 infants (12.2%) required a second paper sample and 527 infants (2.5%) were observed with a liquid urine collection. Of these, the conditions of nine infants with elevated levels of HVA or VMA were investigated clinically for the possible presence of neuroblastoma. Two infants were found to have neuroblastoma; the other seven showed no evidence of tumor. In addition, there were three children who, when screened at 6 months of age, had normal levels of HVA and VMA but in whom neuroblastoma subsequently developed.

3-D structure of a mutant (Asp101-->Ser) of E.coli alkaline phosphatase with higher catalytic activity

Mutagenesis of the absolutely conserved residue Asp101 of the non-specific monoesterase alkaline phosphatase (E.C. 3.1.3.1) from E. coli has produced an enzyme with increased kcat. The carboxyl group of the Asp101 residue has been proposed to be involved in the positioning of Arg166 and the formation of the helix that contains the active site Ser102. The crystal structure of the Asp101-->Ser mutant has been refined at 2.5 A to a final crystallographic R-factor of 0.173. The altered active site structure of the mutant is compared with that of the wild-type as well as with the structures of the mutant enzyme soaked in two known alkaline phosphatase inhibitors (inorganic phosphate and arsenate). The changes affect primarily the side chain of Arg166 which, by losing the hydrogen bond interaction with the carboxyl side chain of Asp101, becomes more flexible. This analysis, in conjunction with product inhibition studies of the mutant enzyme, suggests that at high pH (> 7) the enzyme achieves a quicker catalytic turnover by allowing a faster release of the product.

[Toxic oil syndrome--an example of an exogenously-induced autoimmune disease]

In 1981 epidemic poisoning with adulterated cooking oil occurred in Spain, affecting more than 20,000 people. The condition caused has since become known as the toxic oil syndrome (TOS). About 10-15% of the patients with acute symptoms developed a chronic disease with scleroderma-like skin manifestations, polyneuropathy and myositis. While the acute phase of the TOS was characterized by eosinophilia and elevated IgE, the chronic stage involved humoral autoimmune phenomena, such as antinuclear and antinucleolar antibodies, in many cases. In women with the chronic phase of TOS there was a possible prevalence of HLA-DR3 and HLA-DR4. The recently characterized eosinophilia-myalgia syndrome (EMS), which is thought to have been induced by contaminated L-tryptophan preparations, is similar to the TOS in some particulars. Understanding of the toxicological, immunological and genetic pathways leading to these diseases might give us some insight into the pathogenesis of spontaneously occurring autoimmune diseases, such as systemic scleroderma.

Preradiation intracarotid cisplatin treatment of newly diagnosed anaplastic gliomas. The CNS Cancer Consortium

PURPOSE

This phase II study was performed to assess the response of patients with newly diagnosed, untreated malignant gliomas (anaplastic astrocytoma [AA] and glioblastoma multiforme [GBM]) to intracarotid (IC) cisplatin.

PATIENTS AND METHODS

Eligibility criteria included surgical intervention limited to biopsy only, measurable contrast-enhancing tumor, and unilateral tumor location within the vascular territory of one internal carotid artery. Patients were scheduled to receive four infusions of IC cisplatin (75 mg/m2 every 4 weeks) before beginning standard radiotherapy. Twenty-six patients were treated, and 22 were assessable for response.

RESULTS

Ten patients (45%) showed a greater than 25% decrease in the enhancing tumor area before radiotherapy with stabilization or improvement of neurologic deficits, and three patients (14%) had a greater than 70% decrease in tumor area. The likelihood of response to IC cisplatin was not clearly linked to patient age, tumor histology, or pretreatment tumor size. Myelosuppression, nephrotoxicity, and ototoxicity were mild. Optic neuropathy occurred in one patient, seizures in two, and fatal postinfusion cerebral edema in one.

CONCLUSION

This study design, which permits assessment of the drug sensitivity of the untreated glioma, has shown definite antitumor activity of IC cisplatin in newly diagnosed malignant glioma patients.

Effects of rural roadside levels of nitrogen dioxide on Polytrichum formosum Hedw

Polytrichum formosum Hedw. was exposed to 60 nl litre(-1) (122.4 microm(-3)) NO2 for 37 weeks in a closed chamber fumigation system. This concentration was chosen to simulate roadside levels in rural areas. Over an initial winter period (October-January) growth of existing shoots was stimulated by NO2. When new growth was recorded in April and May, NO2 pollution over winter and spring had resulted in a 36% reduction in new (< 1 cm) shoot production, and a 46% reduction in old shoots showing new growth. It is concluded that plants of Polytrichum formosum Hedw. growing near to roads may be adversely affected by NO2 pollution. Adverse effects of NO2 on plants and possible synergistic effects with other pollutants could cause growth reductions in sensitive species, thus affecting species composition of roadside vegetation.

Rhabdomyolysis associated with severe hyponatremia after prostatic surgery

Transurethral resection of the prostate gland (TURP) has long been associated with disturbances of plasma sodium concentration. Relatively recent substitution of isotonic irrigation solutions has transformed the predominant laboratory abnormality reported from one of hypotonic hyponatremia to one of nearly isotonic hyponatremia with infrequent clinically significant manifestations. We report the unique association of acute and very severe isotonic hyponatremia with rhabdomyolysis and acute renal failure in the post-TURP setting. The mechanism for rhabdomyolysis is postulated to be an impairment of normal maintenance of cellular integrity by virtue of the acuteness and severity of hyponatremia, in the absence of a disturbance of tonicity. Survival after hyponatremia of this severity has not, to our knowledge, been previously reported.

Induction of immunoglobulin G Fc receptors by recombinant vaccinia viruses expressing glycoproteins E and I of herpes simplex virus type 1

Glycoprotein E (gE) of herpes simplex virus type 1 (HSV-1) will bind immunoglobulin G (IgG) (Fc) affinity columns (R. B. Bauke and P. G. Spear, J. Virol. 32:779-789, 1979), but recent evidence suggests that the HSV-1 Fc receptor is composed of a complex of gE and glycoprotein I (gI) and that both gI and gE are required for Fc receptor activity (D. C. Johnson and V. Feenstra, J. Virol. 61:2208-2216, 1987; D. C. Johnson, M. C. Frame, M. W. Ligas, A. M. Cross, and N. D. Stow, J. Virol. 62:1347-1354, 1988). We have expressed gE and gI, either alone or in combination, on the surface of HeLa cells by using recombinant vaccinia viruses and have measured Fc receptor activity by Fc-rosetting or IgG-binding assays. Expression of gE alone resulted in the induction of Fc receptor activity, while expression of gI alone gave no detectable Fc binding. Coexpression of gE and gI resulted in higher levels of IgG binding than did expression of gE alone, despite the fact that under conditions of coexpression, the levels of surface gE were reduced. We propose that gE and gI together form a receptor of higher affinity than gE alone and that HSV-1 therefore has the potential to induce two Fc receptors of different affinities.

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

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

Extraction of DNA from exfoliative cytology specimens and its suitability for analysis by the polymerase chain reaction

The extraction of DNA from archival exfoliative cytology samples would allow the molecular biological analysis of this readily available material using the polymerase chain reaction (PCR). We have quantitatively and qualitatively studied the extraction of DNA from a variety of cytological preparations. For both fresh and archival cervical smears, overnight incubation with proteinase K produces high yields of high molecular weight DNA, but simply boiling the samples produces DNA suitable for PCR amplification of a single copy gene. Increasing the proteinase K incubation to several days allows the extraction of DNA from fixed and stained archival cytology slides from a variety of sites. The extracted DNA was again suitable for PCR analysis. Fresh and archival cytological material can be utilized for molecular biological study of disease processes using PCR. Archival cytological material is probably the best source of DNA and RNA after stored frozen tissue.

Effect of ranitidine on acetaminophen-induced hepatotoxicity in dogs

The effect of ranitidine administration upon the hepatotoxic effect produced by a multidose acetaminophen administration regimen was examined. Seventy-two dogs received three subcutaneous injections of acetaminophen (750, 200, 200 mg/kg body wt) in DMSO (600 mg/ml) at time zero, 9 hr later, and 24 hr after the first dose. Ten control animals (group I) were not given ranitidine, the remaining 62 dogs received an intramuscular injection of ranitidine 30 min before each acetaminophen dose. Three different doses of ranitidine were used (mg/kg body wt): 50 mg, group II (33 dogs); 75 mg, group III (14 dogs); 120 mg, group IV (15 dogs). Ranitidine reduced the expected acetaminophen-induced hepatoxicity in a dose-response manner. Moreover, a significant correlation was found between the ranitidine dose and the survival rate, as evidenced by transaminase levels in the serum and histology of the liver. This model of fulminant hepatic failure induced by acetaminophen and its modulation with ranitidine provides clinical investigators with a research tool that will be useful in the future investigation of putative medical and surgical therapies being investigated for use in the clinical management of fulminant hepatic failure. Because of the size of the animal used in this model, frequent and serial analyses of blood and liver were available for study to determine the effect of therapy within a given animal as opposed to within groups of animals.

Extraction and amplification of DNA from archival haematoxylin and eosin sections and cervical cytology Papanicolaou smears

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Antibodies to Ro/SSA detected by ELISA: correlation with clinical features in systemic scleroderma

Anti-Ro/SSA antibodies were determined by a newly developed enzyme-linked immunosorbent assay in serum specimens from 114 patients with systemic scleroderma in order to examine the relationship between Ro/SSA antibodies and clinical subsets of scleroderma. Sera of 42 patients (37%) were positive for Ro/SSA antibodies. Clinical investigations, including Schirmer's test and enzymatic profiles, demonstrated that 60% (16 of 27) of scleroderma patients with sicca syndrome and 63% (10 of 16) with polymyositis (PM) were Ro/SSA positive. In these patients there was a significant association between Ro/SSA antibodies and rheumatoid factor. HLA-antigens DR2, DR3 and B8 showed an increased frequency in anti-Ro/SSA positive patients.

Correlation of asphyxia and other risk factors with outcome: a contemporary view

The relationships between 14 maternal/prenatal, 24 perinatal and 12 asphyxia-related variables and outcome at 40 weeks, nine, 18 and 36 months were evaluated in a sample of 608 children enrolled in the multi-center National Heart, Lung and Blood Institute Collaborative study. Correlations were weak generally, although they tended to be stronger for perinatal variables and neurological outcome at 36 months. When the maternal/prenatal and perinatal variables (medical/biological), the SES-Composite Index (environmental/psychosocial) and the Early Neuropsychologic Optimality Rating Scale-9 (behavioral/developmental) were used as optimality scales, prediction was enhanced; however, it appeared that the environmental/psychosocial and behavioral/developmental scales were more predictive of 36-month outcome than were medical/biological variable groupings.

The Early Neuropsychologic Optimality Rating Scale (ENORS-9): a new developmental follow-up technique

The development and application of the Early Neuropsychologic Optimality Rating Scale (ENORS-9) is described. This 24-item technique, scored in an optimal/nonoptimal fashion, enables assessment of posture, tone, and movement, as well as developmental delays. The ENORS-9 was compared with the Bayley Mental and Psychomotor Developmental indexes and a neurologic examination administered at 9 months, in terms of sensitivity and specificity of cognitive, motor, and neurologic outcome at 36 months. Using an ENORS-9 cut-off score of 85% for cognitive and motor, and 75% for neurologic outcome, sensitivity values were more than three times greater than more traditional assessment techniques. This instrument meets many needs in developmental follow-up because of straightforward scoring, decreased personnel requirements and cost, and flexibility in regard to missing data and cut-off scores. The implications of these findings are discussed.

Complicated mania. Comorbidity and immediate outcome in the treatment of mania

In a case-control study, 57 manics with antecedent or coexisting nonaffective psychiatric disorders (n = 38) or serious medical illnesses (n = 19) ("complicated mania") were compared with 114 age-, sex-, and year-of-admission-matched controls with no other disorder ("uncomplicated mania"). Significant differences emerged between the three groups in age, marital status, age at onset, number of prior hospitalizations and prior suicide attempts, organic features, and outcome measures (recovery and death rates). Patients were divided into four treatment groups based on primary mode of therapy during index admission; the groups included electroconvulsive therapy, adequate lithium carbonate, inadequate lithium carbonate, and neither treatment. Uncomplicated manics were significantly more likely to receive adequate lithium carbonate and less likely to receive inadequate lithium carbonate than were complicated manics. The latter patients had a significantly poorer immediate response to treatment overall, and to adequate lithium carbonate specifically. Seventy-eight (68.4%) uncomplicated manics had recovered ad discharge, compared with 26 (45.6%) complicated manics. Logistic regression suggested that the influence of comorbidity on outcome was more important for women than men. We conclude that complicated mania is a useful clinical construct.

A computer simulation program to facilitate budgeting and staffing decisions in an intensive care unit

ICUs have unique problems in choosing their best staffing levels for direct patient care because each unit's total patient needs per shift, quantitated in acuity points, vary widely. We devised a computer program to simulate our 12-bed medical/cardiac ICU workload and staffing system. Nursing staffing policies, costs, and availabilities, and a table of past patient acuities per shift were input; total overstaffing, understaffing, and cost per year for full-time nursing equivalents (FTEs) for direct patient care were output for different staffing levels. Using the model, we considered financial concerns, quality of care issues, and staff working preferences and determined that our best staffing level would be based on 5.5 direct FTEs per shift. The stimulation analysis is straightforward, flexible, adaptable, and easy to update and use.

Repeat compartment decompression with partial fasciectomy

After having had a standard decompression for anterior compartment syndrome, five patients presented with persistent symptoms and pressure values above normal. A repeat procedure combined with fasciectomy relieved their pain; postoperative pressure values were normal.

Arthroplasty of the elbow. Experience with the Mark III GSB prosthesis

Forty-five total elbow replacements using the Mark III GSB prosthesis are reviewed. Average follow-up was 2.7 years. The overall results were good in 87% of cases, fair in 9%, and poor in 4%. Excluding the two poor results, which required prosthesis removal, 96% of cases had no significant pain. The flexion/extension are improved 24 degrees and the supination/pronation arc improved 22 degrees. No prosthesis was loose and only one had a significant radiolucent line. The overall complication rate was 25%. Disassembling of the two components, due to inadequate ligament tension, was the most frequent complication and this occurred in four elbows.

Identification of a new glycoprotein of herpes simplex virus type 1 and genetic mapping of the gene that codes for it

A type-specific monoclonal antibody, LP10, precipitated a glycoprotein with a molecular weight of approximately 59,000 from purified herpes simplex virus type 1. Although this glycoprotein was similar in size to glycoprotein D (gD), it was shown to be less abundant in both virions and infected cells, to migrate more rapidly in its precursor form, to incorporate glucosamine but not mannose, and to have a more stable precursor in tunicamycin-treated cells than the gD precursor (pgD). Immunoassays of cells infected with insertion recombinants and intertypic recombinants localized the gene coding for the target antigen of LP10 to the unique short (Us) region at map units 0.892 to 0.924 excluding gD. The target antigen of LP10 was then definitively mapped to the Us4 open reading frame by immunoprecipitation of a polypeptide synthesized by in vitro translation of a Us4-specific transcript prepared by using an SP6 cloning This newly identified glycoprotein product of the Us4 gene of herpes simplex virus type 1 is distinct from the previously identified gB1, gC1, gE1, and gH1.

Intracompartmental pressures on exertion in a patient with a popliteal artery entrapment syndrome

Intracompartmental pressure normally rises during exercise. Pressures in the anterior and deep posterior compartments of the leg were shown to decrease on exertion in a patient with a popliteal artery entrapment syndrome.