Asymptomatic sexually transmitted disease prevalence in four military populations: application of DNA amplification assays for Chlamydia and gonorrhea screening

The prevalence of asymptomatic chlamydial and gonococcal infections in male and female military populations was determined using urine-based ligase chain reaction DNA amplification assays (DAAs). Cross-sectional surveys in four military settings revealed an overall prevalence of asymptomatic chlamydial infection of 4.2% (56/1338). This included 3.4% (21/618) of Western Pacific shipboard US Marine Corps enlisted men; 5.2% (21/406) of male marines shore-based in Okinawa, Japan; 2.7% (5/183) of female enlisted US Navy subtender personnel in dry dock; and 6.9% (9/131) of shore-based female naval personnel in San Diego. No gonococcal infections were detected. All subjects were treated within 2 weeks of screening; none of them had progressed to symptomatic disease. General population-based screening for asymptomatic sexually transmitted diseases, and in particular chlamydial infection, can be successfully implemented using urine-based DAA tests. Benefits are maximized in a population in which compliance for follow-up therapy is high.

Colorectal cancer: a survey of community beliefs and behaviours in Victoria

OBJECTIVE

To document self-reported beliefs and behaviours in relation to colorectal cancer (CRC) and screening for CRC.

DATA COLLECTION

A stratified random sample was selected from the telephone directory, and structured telephone interviews were conducted using a computer-assisted telephone interviewing system.

PARTICIPANTS

500 men and 500 women aged 40-60 years, 70% randomly selected from the Melbourne metropolitan area and 30% from rural Victoria. The response rate to the initial telephone invitation of 1569 eligible people was 63.7%.

OUTCOME MEASURES

Awareness of and experience with CRC; knowledge of CRC risk, risk reduction behaviour, and screening tests for CRC; willingness to have screening tests for CRC; and test preferences.

RESULTS

The people surveyed were relatively unaware of their personal risk of CRC, despite 61% (95% CI, 57%-65%) knowing someone who had CRC. Although 51% (95% CI, 48%-54%) could not name any CRC screening test, 68% (95% CI, 65%-71%) knew of the value of a high fibre diet in prevention. However, 67% (95% CI, 64%-70%) thought it was unlikely they would have a screening test for CRC in the next two years, but 64% (95% CI, 61%-67%) considered that some person could influence their decision to have a test, 60% (95% CI, 56%-64%) stating that they would be influenced by a doctor. Faecal occult blood testing and sigmoidoscopy were equally acceptable. In general, women were more knowledgeable than men. There were no systematic age or urban/rural differences.

CONCLUSIONS

There is a variable understanding of CRC in the community. Although prevention is well understood, this is not true of screening. General practitioners are likely to be influential in the uptake of any screening programs.

Increased levels of phosphatidylinositol 3-kinase activity in colorectal tumors

BACKGROUND

Phosphatidylinositol 3-kinase (PI 3-kinase), an enzyme that phosphorylates inositol phospholipids at the D-3 position of the inositol ring, has been implicated in the signaling pathways regulating cell growth by virtue of its activation in response to various mitogenic stimuli. In spite of the considerable attention PI 3-kinase has received with regard to its possible role in the mitogenic pathways in hematopoietic malignancies, there are few reports of investigations into PI 3-kinase activity in solid tumors.

METHODS

Colorectal tumor tissue and normal-appearing colonic mucosa from the same patients were homogenized and solubilized and adjusted to equal protein levels. PI 3-kinase then was immunoprecipitated from 200 microg of the solubilized tissue using a polyclonal antibody to the p85 subunit of PI 3-kinase. PI 3-kinase activity was assessed using phosphatidylinositol as the substrate and the assay product analyzed by thin-layer chromatography. Phosphorylation of phosphatidylinositol in the D-3 position was confirmed by high performance liquid chromatography analysis of deacylated and deglycerated products.

RESULTS

Thirty-two of the 37 tumors tested (86%) demonstrated increased PI 3-kinase activity compared with normal-appearing mucosa from the same patients (overall mean increase+/-standard error of the mean=3.8+/-0.6-fold; P < 0.05, Student's t test for paired data). The frequency and extent of increased PI 3-kinase enzyme activity in tumors did not correlate with clinical parameters or the presence of oncogenic ras mutations.

CONCLUSIONS

In this study colorectal tumors exhibited enhanced PI 3-kinase activity compared with normal colonic mucosa, raising the possibility that PI 3-kinase may be a potential target for new strategies for the treatment of colorectal carcinoma.

Community (mis)understanding of colorectal cancer treatment

BACKGROUND

A study was undertaken to assess community understanding of colorectal cancer symptoms and colorectal cancer treatment.

METHODS

A computer-assisted telephone survey was undertaken to interview 1000 men and women aged 40-60 years.

RESULTS

Overall there was a considerable lack of information in the community about colorectal cancer symptoms and treatment. Men were less knowledgeable than women, and 28% of men were unable to name any symptoms of bowel cancer. Although surgery was mentioned by 53% of the sample, a third could not name any treatments. Most responses to questions about the effects of treatment related to chemotherapy-related disturbances and the possibility of having a colostomy bag postoperatively.

CONCLUSIONS

There is inaccurate information in the community about colorectal cancer symptoms and treatment. This may inhibit involvement in screening programmes or delay presentation for therapy, as a result of undue concern about the prospects of treatment.

Wilms' tumor presenting as Cushing's syndrome

We report a 2-year-old boy presenting with Cushing's syndrome caused by a Wilms' tumor. This is the fifth such case reported in the English literature.

Achalasia cardia in infancy and childhood: an Indian experience

Seven children with achalasia cardia, six of them infants, were seen over a 10-year period. In infantile achalasia, respiratory symptoms predominate and vomiting may easily be mistaken for gastroesophageal reflux (GER). Vomiting of uncurdled milk is characteristic of achalasia. Six children underwent esophagocardiomyotomy with good results in five. The procedure was transthoracic in two and transabdominal combined with an anterior fundoplication in the others. There was one post-operative death. Achalasia and alacrima were associated in two infants. One baby with this association also had a neurogenic bladder.

Rising incidence of oesophageal adenocarcinoma in men in Australia

Adenocarcinomas of the oesophagus and of the gastric cardia have been reported to be increasing in incidence in many countries, while the incidence of squamous cell carcinoma of the oesophagus is stable and non-cardia gastric cancers are decreasing in incidence. Age-standardized incidence rates for the years 1982-1993 for oesophageal adenocarcinoma and non-adenocarcinoma, and gastric cardia and non-cardia cancers were calculated based on state cancer registry incidence data. Time trends in the age-standardized rates were assessed using linear regression. A consistent increasing trend in the incidence of oesophageal adenocarcinoma in men was seen in all states of Australia and was statistically significant in all states except South Australia. There were no consistent nationwide trends in the incidence of oesophageal adenocarcinoma in women, although a trend towards an increase in the incidence of this cancer reached statistical significance (P < 0.05) in three states (New South Wales, Victoria, Queensland). There were no important trends in the incidence of oesophageal non-adenocarcinoma in either men or women. There were no consistent nationwide changes in the incidence of gastric cardia cancer in either men or women, although this cancer was significantly increasing in Tasmania in both men and women. The incidence of cancer of the stomach not arising at the gastric cardia was significantly decreasing in men in all states and was also decreasing in women in all states, although in women this decrease was statistically significant only in New South Wales, Victoria and Western Australia. There has been a dramatic increase in the incidence of oesophageal adenocarcinoma in men in Australia. The incidence of this cancer in men is now approximately equal with that of non-adenocarcinoma of the oesophagus. The incidence of non-cardia stomach cancer continues to fall.

Seven-year change in graded exercise treadmill test performance in young adults in the CARDIA study. Cardiovascular Risk Factors in Young Adults

PURPOSE

Most studies of physical fitness change have been relatively small, not population-based, and lacking in women and nonwhites. The purpose of this analysis was to evaluate the 7-yr change in physical fitness in a biracial (black and white) population of young men and women.

METHODS

We evaluated change in exercise treadmill test performance in a biracial (black and white) population of 1,962 young adults, ages 18-30 yr at baseline, who completed symptom-limited graded exercise treadmill tests at the baseline (1985-1986) and year 7 (1992-1993) examinations of the CARDIA study.

RESULTS

Mean test duration decreased 58 s (9.5%) over 7 yr (black men, 13.6% decrease, white men, 7.4%; black women, 11.1%; white women, 7.0%). Mean time to heart rate 130 (WL130), a measure of submaximal performance, decreased 31 s (11.3%) (black men, 16.9%; white men, 10.0%; black women, 12.3%; white women, 6.1%). Baseline body mass index (BMI) and physical activity were not statistically significant predictors of test duration change in any race-gender group, but change in BMI and activity were. Seven-year weight gain >20 lbs (31% of cohort) was associated with a large decrease in fitness (18.5% decrease in mean duration, 21.8% decrease in WL130).

CONCLUSION

These data suggest that fitness declines during young adulthood in blacks and whites and that fitness changes are related to changes in weight and physical activity.

Recurrent parotid abscess formation 8 years after an episode of cancrum oris

Recurrent parotid abscess formation as a consequence of isolated right parotid duct osteal stenosis was a very unusual sequela of successfully treated early cancrum oris. Interestingly, it manifested after an uneventful interval of 8 years and required a near-total conservative parotidectomy for cure.

Calcitonin receptors, bone sialoprotein and osteopontin are expressed in primary breast cancers

Several human breast cancer cell lines express the calcitonin receptor (CTR), but this has not been demonstrated previously in clinical breast cancers. We examined 18 primary breast cancers by reverse transcription-PCR, for expression of CTR and of the bone proteins osteopontin (OPN) and bone sialoprotein (BSP). OPN and CTR were expressed by each of the tumours, and 7 (39%) additionally expressed an alternate form of CTR, whilst BSP was expressed by 13 tumours (72%). In situ hybridisation confirmed that expression of OPN and CTR was confined to the tumour cells. Expression of CTR, BSP and OPN may prove to be a useful marker for breast cancers, and their role in the homing of breast cancer cells to bone remains to be investigated.

Shielding properties of laser-induced breakdown in water for pulse durations from 5 ns to 125 fs

The shielding effectiveness of laser-induced breakdown from focused, visible laser pulses from 5 ns to 125 fs is determined from measurements of transmission of energy through the focal volume. The shielding efficiency decreases as a function of pulse duration from 5 ns to 300 fs and increases from 300 fs to 125 fs. The results are compared with past studies at similar pulse durations. The results of the measurements support laser-induced breakdown models and may lead to an optimization of laser-induced breakdown in ophthalmic surgery by reduction of collateral effects.

Frequency and clinico-pathological associations of ras mutations in colorectal cancer in the Victorian population

BACKGROUND

Mutations in the oncogene ras occur in 20-50% of colorectal cancers. The presence of these mutations allows screening tests to be developed based on the identification of mutant DNA in cells derived from cancers. A study of the prevalence and clinicopathological associations of ras mutations was undertaken.

METHODS

The frequency of mutations in codons 12 and 13 of the K-ras gene was investigated in 103 colorectal carcinomas using restriction fragment length polymorphism.

RESULTS

Mutations were detected in 32% (33/103) of the tumours, predominantly in codon 12 (25/33). No mutations were detected in normal-appearing mucosa from the same patients.

CONCLUSIONS

Analysis of the frequency of ras mutations compared with various independent clinical variables revealed a sex-linked relationship between the presence of a ras mutation and nodal status but no correlation with any other clinical parameter was found. The findings suggest that screening tests based on ras mutation detection may lack sensitivity because of the presence of mutations in only 32% of tumours.

Longitudinal relaxation and diffusion measurements using magnetic resonance signals from laser-hyperpolarized 129Xe nuclei

Methods for T1 relaxation and diffusion measurements based on magnetic resonance signals from laser-hyperpolarized 129Xe nuclei are introduced. The methods involve optimum use of the perishable hyperpolarized magnetization of 129Xe. The necessary theoretical framework for the methods is developed, and then the methods are applied to measure the longitudinal relaxation constant, T1, and the self-diffusion constant, D, of hyperpolarized 129Xe. In a cell containing natural abundance 129Xe at 790 Torr, the T1 value was determined to be 155 +/- 5 min at 20 degrees C and at 2.0 T field. For a second cell at 896 Torr, at the same field and temperature, the T1 value was determined to be 66 +/- 2 min. At a higher field of 7.05 T, the T1 values for the two cells were found to be 185 +/- 10 and 88 +/- 5 min, respectively. The 129Xe self-diffusion constant for the first cell was measured to be 0.057 cm2/ s and for the second cell it was 0.044 cm2/s. The methods were applied to 129Xe in the gas phase, in vitro; however, they are, in principle, applicable for in vivo or ex vivo studies. The potential role of these methods in the development of newly emerging hyper-polarized 129Xe MRI applications is discussed.

Seizures and epilepsy in the elderly

Seizures and epilepsy in the elderly are an important and increasingly common clinical problem. Major known causes include cerebrovascular disease, brain tumor, degenerative disorders such as Alzheimer disease and cerebral amyloid angiopathy, and toxic-metabolic syndromes such as nonketotic hyperglycemia, postcardiac arrest, and drug-induced seizures. Recognition of seizures may be complicated by relatively unique clinical presentations and differential diagnosis. Nonconvulsive status epilepticus may present as recurrent episodes of confusion. The electroencephalogram is less useful than in the pediatric age group, but has a role in the evaluation of a first seizure and may rarely show characteristic patterns, such as poststroke periodic lateralized epileptiform discharges. Convulsive status, especially that associated with drug toxicity, is associated with increased mortality in the elderly. Pharmacological treatment is complicated by age-related changes in pharmacokinetics and pharmacodynamics and drug-drug and drug-disease interactions. Some of the new antiepileptic drugs may offer advantages for use in the elderly. Oxcarbazepine has fewer drug interactions than carbamazepine, and gabapentin has one, a reduction of felbamate renal elimination. Vigabatrin causes little cognitive dysfunction, while drugs that reduce excitatory amino acid neurotransmission, such as lamotrigine and felbamate, have potentially protective effects in patients with ischemic cerebrovascular disease. The use of barbiturates, primidone, the benzodiazepine clobazam, and the calcium blockers flunarizine and cinnarizine should preferably be avoided in the elderly.

Phosphotyrosine phosphatase activity in the macrophage is enhanced by lipopolysaccharide, tumor necrosis factor alpha, and granulocyte/macrophage-colony stimulating factor: correlation with priming of the respiratory burst

Tyrosine phosphorylation is now recognised as a key event in the activation of the macrophage respiratory burst. Since vanadate, a phosphotyrosine phosphatase (PTP) inhibitor is able to enhance the respiratory burst, we proposed that agents which prime the macrophage for enhance respiratory burst activity may do so by suppressing cellular PTP activity. The level of PTP activity in murine bone marrow-derived macrophages (BMM) was assessed by the ability of cell lysates to dephosphorylate 32P-labelled RR-src peptide. In contrast to our hypothesis, pretreatment of BMM with bacterial lipopolysaccharide (LPS), tumor necrosis factor alpha (TNF alpha) or granulocyte/macrophage-colony stimulating factor (GMCSF), agents which prime for enhanced respiratory burst activity, was found to dramatically increase the level of cellular PTP activity. The time-course for this increase correlated well with the time course of priming by these agents. In addition, colony stimulating factor-1, a cytokine which does not prime the macrophage respiratory burst, did not enhance PTP levels. The physiological relevance of the increased PTP activity was further supported by confirming it was active against endogenous tyrosine phosphorylated substrates. Interestingly, phorbol myristate acetate and zymosan, agents which trigger the macrophage respiratory burst, were found to inhibit the PTP activity of BMM. Our results demonstrate the regulation of cellular PTP activity by priming agents and further highlight the importance of tyrosine phosphorylation and dephosphorylation events in the regulation of macrophage function.

Intraocular laser surgical probe for membrane disruption by laser-induced breakdown

A fiber probe has been designed as a surgical aid to cut intraocular membranes with laser-induced breakdown as the mechanism. The design of the intraocular laser surgical probe is discussed. A preliminary retinal damage distance has been calculated with breakdown threshold, spot size, and shielding measurements. Collateral mechanical-damage effects caused by shock wave and cavitation are discussed.

Grazing Incidence XUV Spectroheliograph RES-C for the CORONAS-I Mission

The RES-C grazing incidence XUV spectroheliograph has been developed in the P. N. Lebedev Physical Institute (FIAN) as a part of the CORONAS-I project. Its objective is to obtain images of the full Sun in monochromatic lines over the spectral range of 180–210Å, which includes prominent emission from ions of Fe VIII–Fe~XIII, O VI, and Fe XXIV. Here, we describe the optical scheme of the spectroheliograph, and show results of XUV testing of its individual component elements as well as of the complete assembled instrument. XUV measurements were made of the absolute diffraction efficiency and stray-light level for both holographic and mechanically ruled gratings, the spectral reflectivity of the multilayer-coated mirrors, the transmittance of the thin aluminum blocking filters, and the combined spectral efficiency of the whole instrument. The spectral and spatial resolutions of the spectroheliograph were measured by recording spectrally dispersed images of a laser plasma source in monochromatic lines of fluorine ions between 185–200Å. For comparison, we also present spectral images of the Sun obtained with the spectroheliograph as flown on the CORONAS-I satellite mission.

National Survey on Gender Differences in Cardiac Rehabilitation Programs. Patient characteristics and enrollment patterns

PURPOSE

Cardiac rehabilitation (CR) programs have been shown to promote numerous health benefits among patients with active coronary heart disease (CHD), but little is known about the percentage of eligible CHD patients who enroll in CR.

METHODS

A survey was performed of 500 randomly chosen CR programs in operation in the United States during 1990. Patient characteristics and enrollment data were combined with data from the 1990 National Hospital Discharge Survey to estimate the percentage of eligible patients who participated in early outpatient (Phase II) CR programs after myocardial infarction (MI), after coronary angioplasty (PTCA), or after coronary artery bypass surgery (CABS).

RESULTS

Completed surveys were returned by 163 programs (32.6%) with information on 1,322 women and 1,418 men who enrolled in their programs in 1990. Women were older, more likely to be single, and had more traditional CHD risk factors than men. Only a minority of MI, PTCA, and CABS survivors enrolled in CR programs (10.8%, 10.3% and 23.4%, respectively). Enrollment was particularly low for post-MI and post-CABS women as compared with men: 6.9% versus 13.3% (P < .001), and 20.2% versus 24.6% (P < .001), respectively. Enrollment was generally lowest for nonwhites, those over age 65, and those living in the southern United States.

CONCLUSIONS

Cardiac rehabilitation programs are used by a minority of eligible patients, particularly among women, nonwhites, and the elderly. To meet newly released national guidelines that recommend CR services for most patients recovering from MI, PTCA, or CABS, and to still contain costs, new methods need to be explored that can expand the delivery of CR services in clinical settings.

Salmonella Dublin infection in Queensland dairy cattle

OBJECTIVE

To investigate the presence of Salmonella Dublin in Queensland cattle.

DESIGN

An epidemiological study using diagnostic laboratory information and farm records.

PROCEDURE

Outbreaks of gastroenteritis or pneumonia in calves, and abortions and enteritis in cows were routinely investigated for the presence of salmonellae. Where S Dublin was isolated, attempts were made to gather further epidemiological information.

RESULTS

Prior to 1983 only two outbreaks of S Dublin have been recorded in Queensland dairy cattle. In 1983 S Dublin abortions were diagnosed in dairy heifers introduced from southern Australia to south-east Queensland. Sampling indicated that at least 10% of the 500 introduced heifers were faecal excretors of S Dublin. On 3 of the 7 farms from which S Dublin was recorded, infection spread to other cattle that were in contact. From February 1985 to February 1996, 29 outbreaks of S Dublin in cattle occurred on 29 farms (28 in south east Queensland and 1 in north Queensland). Calves were primarily affected. Continuing outbreaks were confirmed on only 4 of these 29 farms. On 15 farms S Dublin infections were associated with the purchase of infected calves or cows, while another farm adjoined 2 previously infected farms. No source of S Dublin was evident for the other 13 farms, where histories were often inadequate.

CONCLUSION

There has been a marked increase in S Dublin outbreaks in Queensland dairy cattle since 1983. Introduction of S Dublin carrier and aborting dairy heifers from southern Australia, where S Dublin is not uncommon, was associated with the initial outbreaks.

The Glasgow Pain Questionnaire: a new generic measure of pain; development and testing

BACKGROUND

The study set out to develop and test a measure of perceived pain suitable for use in community studies and in the evaluation of clinical care.

METHOD

The work had three parts; (1) generation and selection of items, (2) weighting of the items and (3) testing for reliability and validity. Potential items were obtained from 230 informal interviews conducted in a variety of settings. These were reviewed to produce a draft questionnaire, and this was used in a pilot study of 60 volunteers to determine the final item selection. Item weights were calculated using ratings of severity as judged by subjects in the pilot study and the validity testing. Weights are used so that questions referring to more severe pains have higher scores than those about milder pains. Reliability and validity testing was carried out using three groups: 100 rheumatoid arthritis outpatients; 37 attenders at an occupational health clinic and 178 chronic pain clinic patients. Scores from the three different patient groups were compared, scores were compared with a visual analogue measure of pain, and scores from the same individuals from two consecutive months were compared.

RESULTS

DEVELOPMENT

The main product was the new measure itself, the Glasgow Pain Questionnaire (GPQ). This has a total of 24 items in five categories; pain frequency, intensity, emotional reaction, ability to cope and restrictions of daily activity.

TESTING

Validity; scores were significantly different in the three groups. The GPQ scores were significantly related to the visual analogue measure of pain. Reliability; scores of the same respondents on two consecutive months were significantly associated and had a modal value of zero.

CONCLUSIONS

The project has produced a new measure of self-rated pain suitable for use in large-scale population surveys. This instrument assesses not only pain intensity but affective dimensions of pain. It is considered that the validity and reliability testing carried out to date show the measure as acceptable for use in future studies.

Incidence trends in oesophageal and proximal gastric carcinoma in Victoria

BACKGROUND

There is clinical evidence that adenocarcinoma of the lower oesophagus is increasing in the Australian society. The population-based cancer registry of Victoria was used to describe the incidence of adenocarcinoma of the oesophagus and gastric cardia.

METHODS

Data were obtained from 1982 to 1991 and were analysed using the Poisson regression techniques.

RESULTS

In men, a statistically significant annual increase of 9.5% in oesophageal adenocarcinoma and a non-significant increase of 1.6% in adenocarcinoma of the gastric cardia was observed. These increases were balanced by decreases in other histological types found in the oesophagus in men resulting in little change in the overall rate. No significant trends by age or histological type were observed in women.

CONCLUSIONS

There is evidence for a rise in adenocarcinoma in men in Victoria. Possible risk factors include Barrett's oesophagus.