Mothering behavior and maternal role attainment during the postpartum period

Relationships among subjective and behavioral components of maternal role attainment were investigated separately for 64 primiparous and 60 multiparous mothers. The influence of contextual variables on maternal behavior was also examined. Subjects were medically low risk with normal infants. Attitudes toward themselves and their infants and feelings of self-confidence were measured at 1 to 2 days and 4 to 6 weeks after delivery. At 4 to 6 weeks mothers were also videotaped performing an infant feeding at home. Tapes were rated for maternal sensitivity and responsivity. For primiparas, self-confidence was related to maternal feeding behavior as were maternal age, education, and socioeconomic class. For multiparas, only initial attitude toward self was related to maternal behavior; however, maternal age and infant size were contextual factors related to behavior. Distinctions proposed among subjective and behavioral components are in part supported by the findings of the study.

Direct analysis of plasma fibrinogen-derived fibrinopeptides by high performance liquid chromatography: investigation of A alpha-chain N-terminal heterogeneity

Fibrinopeptide A (FPA), released from the fibrinogen A alpha-chain by thrombin, can be resolved by high-performance liquid chromatography (HPLC) into three forms, the intact peptide (A), a modified peptide phosphorylated at the serine in position 3 (AP), and an N-terminally degraded form (AY). A new method has been developed, using HPLC, that allows direct measurement of the proportions of AP, A, and AY released by thrombin from fibrinogen in plasma samples of 200 ul or less. The method was used to examine variations in the proportions of AP and AY expressed as a % of total FPA in a number of patient and control groups. The mean percentages of AP and AY of plasma fibrinogen were found to be 21.7 and 14.2%, respectively, in normal laboratory controls. In older, apparently normal, individuals these figures were 27.0 and 15.5%, respectively. Cord plasma exhibited very high AP and slightly reduced AY levels (41.6 and 12.4%, respectively) compared with normal adults. Patients with liver failure had low AP levels and high AY levels (11.6 and 21.1%, respectively). Patients recovering from major surgery or acute thrombotic stroke showed an acute-phase rise in fibrinogen level that was accompanied by an increase in AP and variable reduction in AY. Incubation of heparinized whole blood for 8 days in vitro demonstrated a gradual decrease in the proportion of AP and increase in AY of plasma fibrinogen. These results provide some support for the idea that an increased "aging" of fibrinogen in the circulation may result in a decrease in the AP content of fibrinogen accompanied by a more variable increase in AY.

Central nervous system toxicity following the treatment of pediatric patients with ifosfamide/mesna

Ifosfamide/mesna treatment of 50 patients with pediatric malignant solid tumors was associated with the development of neurotoxic signs and symptoms in 11 of these individuals who received 29 courses of treatment. Neurologic toxicity included changes in mental status, cerebellar function, cranial nerve, and cerebellar and motor system function, including seizures. All symptoms, signs, and EEG abnormalities were transient. Some of the affected individuals failed to develop acute neurotoxic signs of symptoms when retreated with ifosfamide. A grading system for scoring these neurologic abnormalities is presented for comparison of acute neurotoxic effects of other agents. Recommendations are made regarding early termination or delay of ifosfamide/mesna treatments in the presence of significant neurotoxicity.

Direct analysis of plasma fibrinogen-derived fibrinopeptides by high-performance liquid chromatography

The fibrinopeptides released from fibrinogen by thrombin can be conveniently quantitated by high-performance liquid chromatography (HPLC). This work describes a method that enables direct analysis of fibrinopeptides derived from fibrinogen contained in small amounts of plasma or whole blood without the necessity of fibrinogen purification. Aliquots of plasma or whole blood were treated with thrombin, diluted in buffer at pH 6.0, boiled and centrifuged. After filtration to 0.22 micron the supernatant was analysed directly by HPLC using a 3 microns C18 analytical column fitted with a pre-column. All the known normal fibrinopeptide peaks and their degradation products were clearly resolved from other plasma-derived peptides and the release pattern was identical to that observed with purified fibrinogen. Some samples contained interfering endogenous peptides which were removed by rapid gel-filtration of 200 microliters of plasma before thrombin treatment. The method was quantitative and the peak heights of fibrinopeptide B (FPB) could be used to accurately measure plasma fibrinogen concentrations directly in samples equivalent to 20 microliters of plasma. These fibrin determinations were unaffected by the type of anticoagulant used were performed on blood samples of both human and animal origin collected and/or stored under a variety of conditions. Variations of the method were specifically developed for different applications requiring quantitative fibrinopeptide analysis.

An autosomal recessive mental retardation syndrome with hepatic fibrosis and renal cysts

Two sisters had developmental retardation and congenital hepatic fibrosis. One, 23 years old, had facial anomalies reminiscent of Smith-Lemli-Opitz syndrome, ocular coloboma, and hypoplastic kidneys with a single cyst. The other sister died at 18 months and had an encephalocele and cystically dilated collecting ducts in the renal medulla. Although the manifestations in these two sisters are similar to the Smith-Lemli-Opitz and Meckel syndromes respectively, there are sufficient differences to suggest that they had a separate autosomal recessive MCA-MR syndrome.

DNA repair in nondividing human lymphocytes: inhibition by deoxyadenosine

Resting peripheral blood lymphocytes have a large number of single strand breaks and are especially sensitive to DNA damaging agents. Deoxyadenosine, an adenosine deaminase substrate, in combination with the adenosine deaminase inhibitor deoxycoformycin, causes accumulation of single strand breaks in resting peripheral blood lymphocytes. The induction of single strand breaks by deoxyadenosine is the result of the accumulation of large amounts of intracellular dATP, which creates imbalance in deoxynucleoside triphosphate levels. This imbalance in deoxynucleoside triphosphate levels interferes with the repair of single strand breaks in deoxyadenosine treated cells. Deoxyadenosine acts synergistically with N-methyl-N'-nitro-N-nitrosoguanidine, a DNA alkylating agent, by inhibiting the repair of N-methyl-N'-nitro-N-nitrosoguanidine-induced single strand breaks. We propose that the increased sensitivity of resting peripheral blood lymphocytes to deoxyadenosine and possibly to other DNA damaging agents may be associated with impaired DNA repair ability due to imbalance in intracellular levels of deoxynucleoside triphosphate.

Stapled cholecystojejunostomy and gastrojejunostomy for the palliation of unresectable pancreatic carcinoma

This technique of combined gastrojejunostomy and cholecystojejunostomy utilizing gastrointestinal staplers provides a quick, simple, safe, and effective means for palliation of biliary and duodenal obstruction occurring in patients with unresectable carcinoma of the head of the pancreas. Use of a common loop of jejunum for both biliary and gastric bypass avoids the complexities of other reported methods.

Maternal role attainment and identity in the postpartum period: stability and change

Stability and change in maternal identity and maternal role attainment were examined in 64 medically normal, middle-class primiparous and 58 multiparous women. Using two semantic differential scales, "Myself as Mother" and "My Baby", for maternal identity and the Pharis (1978) Self-Confidence Scale for role attainment, subjects were tested at 1 to 3 days and 4 to 6 weeks postpartum. Main effects for parity and testing occasions were found for both semantic differential scales. While mothers' attitudes toward themselves became more positive over time, those toward their babies became less positive. Self-confidence showed main effects for both time of testing and parity as well as interaction effects. Although attitudes and self-confidence were stable across testing occasions, self-confidence was less related to indicators of maternal identity for multiparas than for primiparas. Sociodemographic variables demonstrated only low correlations with indicators of maternal identity and role attainment. Testing the relationship of maternal identity and role attainment to actual parenting behaviors is needed to determine the empirical and practical import of these two concepts in nursing practice.

Evidence against the structural gene encoding type II collagen (COL2A1) as the mutant locus in achondroplasia

The structure of the locus encoding the major cartilage collagen gene (COL2A1) was studied in a total of 19 cases of achondroplasia. No gross rearrangements were seen. The segregation of COL2A1 was examined in three affected kindreds using restriction site and length variants as genetic markers. In two kindreds discordant segregation between the achondroplasia and COL2A1 loci was demonstrated. Paternity/maternity was confirmed using a 'minisatellite' core sequence probe which reveals cross hybridising polymorphic loci.

Characterization of peptides cleaved by plasmin from the C-terminal polymerization domain of human fibrinogen

The C-terminal region of the fibrinogen gamma chain is known to participate in several functional interactions including fibrin polymerization. This part of the molecule is retained on the gamma chain of fragment D (FgD) when fibrinogen is digested by plasmin in the presence of calcium to produce the fragment D-fragment E (FgD X FgE) complex but is lost if FgD is prepared in the absence of calcium. In an attempt to characterize the C-terminal polymerization domain we have used three techniques to examine this further degradation of FgD following the addition of EDTA and plasmin. Analysis of the digestion by sodium dodecyl sulfate-polyacrylamide gel electrophoresis showed a progressive cleavage of the gamma chain to two small remnants. The polymerization-inhibitory activity of the whole digest was studied using acid-solubilized fibrin. A progressive loss of inhibitory activity was associated with gamma chain shortening, reaching greater than a 120-fold reduction at the end of digestion. The cleavage of peptides was followed by reverse-phase high performance liquid chromatography and the release of a characteristic peptide triplet was associated with gamma chain cleavage. Manual sequencing, amino acid analysis, and fast atom bombardment mass spectrometry established the three peptides as gamma 303-356, 357-373, and 374-405. These peptides have sequences in common with those peptides recently reported by other investigators to be potent polymerization inhibitors. However, when a mixture of the three peptides was added in a 200-fold molar excess to polymerizing fibrin, no inhibitory activity could be demonstrated. It is concluded that the C-terminal polymerization domain of fibrinogen may be an extended region which includes the sequence gamma 303-405, when this is contiguous with the remainder of the gamma chain.

Phenotypic variation in LADD syndrome

A mother and son are reported with chronic dacrocystitis, cup shaped ears, hearing loss, abnormal teeth, and poor formation of saliva and tears. They are similar to previously reported cases of lacrimo-auriculo-dento-digital (LADD) syndrome. The variability of expression of this autosomal dominant syndrome is discussed, and it is suggested that poor saliva and tear formation be added to the phenotype.

The Nager acrofacial dysostosis syndrome with the tetralogy of Fallot

A male infant is described with mandibulofacial dysostosis and absent thumbs, consistent with the Nager acrofacial dysostosis syndrome. In addition, the tetralogy of Fallot was present. Major congenital heart malformations occur rarely in this syndrome.

Seckel syndrome: an overdiagnosed syndrome

Five children in whom a diagnosis of Seckel syndrome had previously been made were re-examined in the genetic unit. One child had classical Seckel syndrome, a sib pair had the features of the syndrome with less severe short stature, and in two children the diagnosis was not confirmed. Seckel syndrome is only one of a group of low birth weight microcephalic dwarfism and careful attention should be paid to fulfillment of the major criteria defined by Seckel before the diagnosis is made. There remains a heterogeneous group of low birth weight microcephalic dwarfism yet to be defined.

Characterization of mouse lymphoma cells with altered nucleoside transport

A mutant clone (NT-1) of a T-cell lymphoma was selected for its ability to grow in HAT medium (hypoxanthine, aminopterin and thymidine) in the presence of the nucleoside transport inhibitor P-nitrobenzyl-6-mercaptoinosine (NBMI). NT-1 cells contain half the number of NBMI binding sites present on the parental S49 cells and are partially able to transport nucleosides in the presence of the transport inhibitor (NBMI). These observations suggest that the mutant cells are heterozygous for nucleoside transport proteins and contain two types of transport proteins: the first protein can both bind and is inhibited by NBMI similar to the wild type phenotype, and the second is an altered protein. The altered transport protein apparently lost its NBMI binding sites without a parallel loss of nucleoside transport ability suggesting that the nucleoside transported sites are separate from the binding sites of the transport inhibitor.

A diagnostic-prognostic test for bladder cancer using a monoclonal antibody-based enzyme-linked immunoassay for detection of urinary fibrin(ogen) degradation products

An enzyme-linked immunosorbent assay (ELISA) using a monoclonal antibody was developed to determine the clinical value of urinary fibrinogen/fibrin degradation product levels for the identification and management of patients with bladder cancer. Assays were performed on 286 serial urine specimens from 56 bladder carcinoma patients. Specimens were grouped according to whether the patient had an evident tumor at the time of specimen collection (134 specimens, 41 patients) or was clinically disease-free following treatment (152 specimens, 38 patients). Many patients contributed specimens to both groups as determined by their clinical status at the time of collection. In addition, 45 specimens from 33 patients with inflammation of the urogenital tract and 81 specimens from 19 patients with renal or prostatic cancer were assayed for urinary fibrin degradation products. The ELISA, using a high-sensitivity procedure, identified 83% of the specimens from bladder cancer-positive patients with an overall accuracy with all specimens of 78% and a false-negative rate of 5% for all specimens tested. The high-sensitivity ELISA appeared most appropriate for monitoring bladder cancer patients for recurrence of tumor after surgery. The ELISA using a high-specificity procedure appeared most appropriate for screening. The high-specificity ELISA accurately identified 96% of urine specimens from non-bladder cancer patients with a false-positive rate of only 5%. These results demonstrate that the ELISA is an efficient, reliable, quantitative, and noninvasive immunoassay that can be useful both for the identification of bladder cancer patients and for monitoring the course of the disease.

Fast computer search for similar DNA sequences

An extremely fast method of searching a nucleic acid sequence database against a probe sequence is described. The method is based on the detection of deviation from expected number and deviation from random spatial distribution of sub-sequences which are unique within a sequence, and shared between that sequence and the probe. On an IBM 3081 computer, total search of an encoded form of the EMBL nucleic acid sequence database with a 1 kbase probe sequence is completed in a few seconds. Previous best methods for a similar task required a few minutes.

Experimental evidence for renal catabolism of fibrin fragment beta 15-42

The elimination of labelled human fibrin fragment beta 15-42 from the circulation has been studied in an experimental rat model. When 125I beta 15-42 was injected as a bolus into a control group of rats, its elimination from the circulation could be fitted to a two compartment exponential model. A fast initial elimination had a t1/2 of less than 2 min and this was followed by a slower component with a calculated t1/2 of 135 min. The fast component was caused by equilibration of peptide throughout the intra and extra vascular spaces and the slow component reflected the action of catabolic processes once equilibration had been attained. Rats that had undergone bilateral nephrectomy eliminated significantly less of the labelled peptide than the control animals at a given time and the t1/2 of the slow component was prolonged, but not significantly, to 159 min. Rats with ligated ureters had statistically indistinguishable elimination curves from control rats. Examination of the heterogeneity of labelled peptide in plasma samples taken during the experiments by immunoprecipitation and by gel filtration revealed progressive extensive degradation in the control and ureteral ligated rats, but less degradation in nephrectomized rats. These results suggest that beta 15-42 is eliminated, in part, from the circulation by uptake and catabolism by the kidney. It is concluded that impaired renal function may results in elevated plasma levels of beta 15-42 antigen in human renal failure without the need for an increased rate of production of the peptide.

Titratable effects of p-chloromercuriphenyl sulfonate, a thiol-attacking reagent, on glucocorticoid receptor binding

Cytosol prepared from cultured AtT-20 mouse pituitary cells or mouse liver was treated with concentrations of p-chloromercuriphenyl sulfonate (PCMPS) which reduced but did not abolish receptor-binding activity. Scatchard analysis of triamcinolone acetonide binding to the treated cytosol showed that the PCMPS effect was caused by a reduction of binding affinity with little effect on the apparent binding site concentration. The effect on affinity was dose-dependent. Binding specificity appeared unaffected since the relative abilities of triamcinolone acetonide, dexamethasone, cortisol, progesterone, and corticosterone to compete with labeled triamcinolone were similar at various PCMPS concentrations which caused a progressive reduction of detectable cytosol binding. The PCMPS effect was reversible since cytosol treated with up to 200 microM PCMPS followed by dithiothreitol 15 min later showed nearly complete recovery of binding sites (62-100%). The possibility that several sulfhydryl groups were involved in this phenomenon was further explored in experiments using AtT-20 cytosol labeled with [3H]dexamethasone-mesylate, a glucocorticoid affinity label which binds covalently to sulfhydryl groups. Chromatography of dexamethasone-mesylate labeled receptor on a sulfhydryl affinity column resulted in binding, indicating that the receptor had at least two sulfhydryl groups, one bound to the mesylate moiety of the steroid and the other capable of binding to the affinity column.

Hydrocele formation in patients with Hodgkin's disease

Hydroceles developed in 12 (7.7%) of 155 consecutive male patients who had Hodgkin's disease treated between 1962 and 1981. Except for one patient who had a hydrocele at diagnosis, all developed this complication during remission, 8 months to 7.5 years after inverted-Y or abdominopelvic 60Co irradiation (3000-3800 rad). Hydroceles were bilateral in five patients and on the right side in seven. No tumor was found in the hydrocele sacs of the ten patients who underwent hydrocelectomy. Lymphatic obstruction was evidenced by lymphatic dilation in the hernia sac in six patients. The authors believe postirradiation fibrosis of the lymphatic pathway was the main cause of hydrocele formation.

Delayed release of an abnormal fibrinopeptide A from fibrinogen Manchester: effect of the A alpha 16 Arg leads to His substitution upon fibrin monomer polymerization and the immunological crossreactivity of the peptide

Fibrinogen Manchester is an abnormal fibrinogen with an impaired release of fibrinopeptide A (FPA) and a polymerization abnormality. In the accompanying article we have identified the amino acid substitution in fibrinogen Manchester as A alpha 16 Arg leads to His. When fibrinogen Manchester was digested with low thrombin concentrations approximately 40-50% of the total FPA content was release at a rate similar to FPA release from normal fibrinogen. The fibrin so formed exhibited an impaired polymerization of monomers. Digestion of fibrinogen Manchester with high concentrations of thrombin for prolonged times released the remaining FPA which had an abnormal retention time when studied by high performance liquid chromatography (HPLC). This fibrinopeptide has been shown previously to contain the A alpha 16 Arg leads to His substitution. fibrin resulting from this exhaustive digestion had normal polymerization of monomers. The normal and substituted FPAs were isolated by HPLC and compared in a double antibody competitive-binding assay for normal FPA. The immunological cross-reactivity of the abnormal peptide was reduced, so that approximately 5 times more abnormal peptide was required on a molar basis to displace labelled normal FPA. Normal intact fibrinogen was 10-fold less reactive (on a half molar basis) than free normal FPA and the crossreactivity of fibrinogen Manchester was measurably less than that of normal fibrinogen. It is concluded that immunological measurement alone of FPA released from abnormal fibrinogens may not give a complete description of the kinetics of peptide release if the amino acid substitution lies within the FPA sequence. The combination of radioimmunoassay and HPLC, however, provides a powerful analytical approach that should be useful in classifying and characterizing abnormal fibrinogens.

Long-term results of treatment of children and adolescents with Hodgkin's disease

Fifty-four children and adolescents with Hodgkin's disease Stages I--IV were treated with chemotherapy plus radiotherapy from 1967 to 1972. Thirty-eight patients (70%) remain in continuous complete remission. Nine patients have died, four of progressive disease, three of pneumonitis, one with probable pneumococcal sepsis, and one of acute myelocytic leukemia. Significant retardation of height and crown-rump length occurred, particularly in boys who received at least mantle or abdominal radiotherapy when younger than age 16 years. Five women have amenorrhea and no patient has clinical evidence of hypothyroidism. The major long-term effects of therapy in this group of patients has been growth retardation. Future studies to minimize long-term effects of therapy are necessary but must be carefully designed so that present cure rates are not jeopardized.

Motor neurone disease with elevated cerebrospinal fluid protein

The correlation between age and CSF protein in 38 patients with pathologically proven motor neurone disease was the reverse of that described for normal subjects by Tibbling et al in 1977. Eight had CSF protein ranging from 0.75 g/1 to 1.52 g/L. These patients were younger, but other clinical and gross and light microscopy pathological features were not significantly different from those with lower CSF protein. Transudation from serum may be only one of the mechanisms underlying this elevation in CSF protein.

Efficacy of transfusion therapy for one to two years in patients with sickle cell disease and cerebrovascular accidents

Since 1974 we have entered 12 children with sickle cell disease and strokes on a transfusion protocol to maintain hemoglobin S less than 20%. Serial arteriography, EEGs, brain or CT scans, and neuropsychologic testing were also obtained. Transfusion has been stopped in ten patients after one to two years. Seven of these ten patients have had second strokes five weeks to 11 months after cessation of transfusion (median three months). Arteriography was normal at the time of the initial stroke in two patients; one of these had a second stroke. Arteriograms did not improve during transfusion therapy. EEGs and brain and CT scans were occasionally useful at the time of the initial stroke but were of little value in following these patients. Neuropsychologic testing indicated severe impairment of sensory-motor and cognitive processes at the time of the initial stroke and was useful in following improvement or deterioration and in designing remedial education programs. We conclude that short-term transfusion therapy will not prevent second strokes once transfusion is stopped and that arteriography is of limited value in these patients.

Prophylactic and therapeutic activity of Rofenaid-40A in an experimental Escherichia coli airsac infection in chickens

Rofenaid at a 0.02% dose level in feed was effective prophylactically and therapeutically against an experimentally induced Escherichia coli airsac infection in chickens. The activity of Rofenaid compared very favorably with that of the approved dose level of NF-180. Furthermore, the prophylactic use of Rofenaid did not interfere with the therapeutic efficacy of NF-180.

Pedicle fat grafts for the prevention of scar formation after laminectomy. An experimental study in dogs

The formation of scar tissue always follows lumbar disc surgery and usually causes no difficulty. Reoperation may be necessary because of disc reherniation or because of the scar tissue itself. Reoperation is tedious and dangerous because of the presence of scar formation. Beginning in February 1975, the authors performed laminotomies in 107 dogs in an attempt to study the possibility of prevention of scar tissue formation about the dural sac and nerve roots. Gelfoam and Gelfilm were found to increase scar formation. Micropore tape and plastics such as polyethylene, mylar, and woven and smooth silastic were tried without complete success. Free fat grafts gave better protection than other substances, but it was found that pedicle grafts of fat gave more complete prevention of scar. The living pedicle fat grafts also prevented the usual closure of the laminotomy. The technique of pedicle fat grafts has also been used with success in 36 human patients to date.

Value of serum copper levels and erythrocyte sedimentation rates as indicators of disease activity in children with Hodgkin's disease

Initial and serial serum copper levels (SCL) and erythrocyte sedimentation rates (ESR) of 29 children with Hodgkin's disease were reviewed to determine the relationship of these features to disease activity. Only six of 10 patients who relapsed had SCL greater than adult upper normal levels. Although correction for age increased this to 7, it also increased the number of patients with false positive results to 9 of 19. Although 9 of the 10 patients at relapse had an increase in SCL over the preceding value, almost one-fifth of patients in remission had increases in consecutive SCL greater than the average increase of patients who relapsed. We conclude that SCL, even when age corrected and consecutively followed, are not useful as indicators of disease activity in children with Hodgkin's disease. Although the ESR increased to greater than 20 mm/hour in 9 of 10 patients who relapsed, this determination could not be considered a useful early indicator of disease recurrence since it was so frequently elevated in patients who were free of disease (62 of 109 determinations). The extremely nonspecific nature of SCL and ESR in childhood renders these tests unreliable, particularly in the individual child.

Cardiovascular effects of novel amphetamine analogs in anesthetized rats

In albino, adult Sprague Dawley rats, anesthetized with urethane intraperitoneally, the effects of the exo- and endo-isomers of 2-amino-5,8-dimethoxybenzonorbornene were studied on arterial blood pressure and heart rate. Both compounds produced an immediate rise in systemic arterial pressure followed by an immediate maximal depressor response. The depressor effect was sustained beyond 30 minute duration, but declined in intensity with time to nearly preinjection levels. Both compounds decreased heart rate in varying degrees. Evidence of marked bradycardia and onset of toxicity was observed at doses of 12.8 mg/kg (exo) and 19.2 mg/kg (endo). The biphasic response seen after intravenous injection of the compounds suggests an initial vasoconstrictory followed by a vasodilatory effect.