Carcinoid tumors of the lung and family history of cancer

Family history of cancer has been described among patients with lung neoplasms. Carcinoid tumors, originally thought to be slow growing and nonmetastatic, have not historically been included in these studies. In some instances these tumors have demonstrated aggressive metastatic potential. A medical record review of 86 patients with histopathologically confirmed carcinoid tumors of the lung, treated at the University of Texas M.D. Anderson Cancer Center between 1959 and 1994, was conducted to describe family history of cancer. Family history of cancer was recorded in 74 (86%) of the medical records and 32 (43%) reported first-degree relatives with cancer. Five-year survival for patients with affected relatives was 45% and 73% for patients without affected relatives (p = .23). Among 67 patients without metastatic disease at diagnosis, the risk of distant metastasis by 5 years was 40% among patients with a positive family history of cancer compared to 6% of the patients without affected relatives (p = .03), (rate ratio 5.01). These results suggest that genetic susceptibility may affect the metastatic potential of some carcinoid tumors.

Perceptions of Species Abundance, Distribution, and Diversity:Lessons from Four Decades of Sampling on a Government-Managed Reserve

/ We examined data relative to species abundance, distribution, anddiversity patterns of reptiles and amphibians to determine how perceptionschange over time and with level of sampling effort. Location data werecompiled on more than one million individual captures or observations of 98species during a 44-year study period on the US Department of Energy's(DOE) Savannah River Site National Environmental Research Park (SRS-NERP) inSouth Carolina. We suggest that perceptions of herpetofaunal speciesdiversity are strongly dependent on level of effort and that land managementdecisions based on short-term data bases for some faunal groups could resultin serious errors in environmental management. We provide evidence thatacquiring information on biodiversity distribution patterns is compatiblewith multiyear spatially extensive research programs and also provide aperspective of what might be achieved if long-term, coordinated researchefforts were instituted nationwide.To conduct biotic surveys on government-managed lands, we recommend revisionsin the methods used by government agencies to acquire and report biodiversitydata. We suggest that government and industry employees engaged inbiodiversity survey efforts develop proficiency in field identification forone or more major taxonomic groups and be encouraged to measure the status ofpopulations quantitatively with consistent and reliable methodologies. Wealso suggest that widespread academic cooperation in the dissemination ofinformation on regional patterns of biodiversity could result byestablishment of a peer-reviewed, scientifically rigorous journal concernedwith status and trends of the biota of the United States. KEY WORDS: Abundance; Amphibian; Biodiversity; Distribution; Landmanagement; Reptile

L-arginine administration during reperfusion improves pulmonary function

BACKGROUND

Nitric oxide is crucial to the maintenance of vascular homeostasis. Because nitric oxide levels decline upon lung reperfusion, infusion of L-arginine, a nitric oxide precursor, during reperfusion might prove effective at ameliorating reperfusion injury.

METHODS

Neonatal piglet heart-lung blocks were preserved with Euro-Collins solution for 12 hours, rewarmed at room temperature for 1 hour, and reperfused for 10 minutes with either whole blood (n = 5), whole blood containing L-arginine (10 mmol/L; n = 6), or leukocyte-depleted blood (n = 6) on an isolated, blood-perfused, working heart-lung circuit. After the initial 10 minutes, all blocks received whole blood for 4 hours. Control blocks were continuously perfused on the circuit without intervening ischemia (n = 6).

RESULTS

The partial pressure of oxygen in the whole blood group (113.8 +/- 33.1 mm Hg) was significantly less than in controls (417.3 +/- 6.2 mm Hg; p < 0.01). Lung compliance was significantly less in the whole blood group (0.8 +/- 0.2 mL/cm H2O) than in controls (2.9 +/- 0.4 mL/cm H2O; p < 0.01). The L-arginine and leukocyte-depleted blood groups showed no significant difference from controls.

CONCLUSIONS

L-Arginine infusion during reperfusion improves pulmonary function, making it a simple alternative to leukocyte depletion.

Indications for and timing of surgical intervention in infective endocarditis

Infective endocarditis, especially when it involves prosthetic valves, is a serious, often fatal illness. Although antibiotics are essential in management, surgery is required in many patients who develop even incipient heart failure and structural complications. Early identification and referral results in improved mortality and morbidity rates, and there is evidence that surgery should play a larger role in managing infective endocarditis. Patients with intracardiac pacemakers and cardioverting devices represent a growing reservoir of patients with the potential to develop endocarditis.

Who uses screening mammography regularly?

We evaluated factors associated with the regular use of screening mammography among women presenting for screening. Six thousand two hundred forty-four women ages 55 and older who participated in the 1991-1992 Texas Breast Screening Project were classified as regular or irregular users of mammography according to self-reported mammographic history since 1986. Logistic regression was applied to determine odds ratios of specified factors. Fourteen % were regular users of mammographic screening. Being older, black or Hispanic, receiving regular care from a family doctor, believing in a lower prospect of cure of breast cancer, and lacking health insurance coverage were associated with less regular use of screening mammography. Higher educational level, family history of breast cancer, prior breast biopsy, annual income > or = +35,000, receiving regular care from a gynecologist, believing that life would be difficult with breast cancer, and believing in a greater personal risk for breast cancer were associated with a greater likelihood of regular use (P < 0.01). Among multiple factors associated with regular use of screening mammography, sociodemographic variables associated with regular mammography use are similar to those influencing initial use of screening mammography. Women who are difficult to persuade to obtain mammographic screening may be equally difficult to persuade to adhere to regular use.

Prognosis of amyotrophic lateral sclerosis and the effect of referral selection

We followed two cohorts of Amyotrophic Lateral Sclerosis (ALS) patients to examine the survival and prognostic factors of ALS and the impact of selective referral on prognosis of ALS. The first cohort consisted of population-based incident ALS cases from Harris County, Texas, first diagnosed between 1985 and 1988. The second was a clinical series from a tertiary care center in Houston, Texas, diagnosed between 1977 and 1989. The overall 3-year survival was 29% in the incidence cohort and 32% in the referral cohort; however, the 5-year survival was much lower for the incidence cohort than the referral cohort (4% vs 21%). The large difference in 5-year survival was not explained by the distributions of prognostic factors in the two cohorts but due to stronger unfavorable effects of prognostic factors in the incidence cohort than the referral cohort. In both cohorts, older age at diagnosis, bulbar onset, and positive family history of ALS were unfavorable prognostic factors while blacks had better survival than whites or hispanics. We confirmed that longer duration from onset to diagnosis was a favorable prognostic factor in both cohorts but the effect was more pronounced in the referral series.

Extracellular and standard University of Wisconsin solutions provide equivalent preservation of myocardial function

The deleterious effect of hyperkalemic cardioplegic solutions on coronary endothelium has been documented and has also been demonstrated with University of Wisconsin solution. We evaluated a new extracellular University of Wisconsin formulation for efficacy in heart preservation. Six neonatal piglet hearts were arrested with and stored in the standard intracellular University of Wisconsin solution (group 1: K+ 125 mEq/L, Na+ 29 mEq/L). Six piglet hearts were preserved for 24 hours with an extracellular University of Wisconsin solution that differed only in the concentrations of potassium and sodium (group 2: K+ 25 mEq/L, Na+ 129 mEq/L). Hearts underwent modified reperfusion with leukocyte-depleted aspartate-glutamate enriched blood cardioplegic solution followed by conversion to a left-sided working mode on a Langendorff circuit with perfusion from a support pig. Stroke work index was calculated at left ventricular end-diastolic pressures of 3, 6, 9, and 12 mm Hg. Sixty minutes after reperfusion, there was no significant difference in stroke work index between group 1 (16.4 +/- 1.9 x 1000 erg/gm) and group 2 (15.3 +/- 2.7 x 1000 erg/gm). There was also no significant difference in high-energy phosphate stores or myocardial water content between the two groups. Extracellular University of Wisconsin solution provides myocardial preservation equivalent to standard University of Wisconsin solution while preventing exposure of coronary endothelium to high levels of potassium, which justifies its use in clinical heart transplantation.

Secular trends and birth cohort effects in unprovoked seizures: Rochester, Minnesota 1935-1984

The incidence of idiopathic/cryptogenic epilepsy and isolated unprovoked seizures has been relatively stable in the population of Rochester, Minnesota, for the 50-year period 1935 through 1984. In each decade, the age-specific rates exhibited a consistent U-shaped pattern of decreasing rates from infancy to age 40-49 and a progressive increase thereafter to a second peak at age 70 years. Males had a 15% higher incidence of cryptogenic unprovoked seizures than females. The most pronounced secular trend was a decrease in the incidence in children aged < 10 years for the first 4 decades of the study; however, this trend was interrupted by a slight rebound in the decade 1975-1984. There has been a progressive decrease in the incidence of cryptogenic unprovoked seizures in individuals aged > or = 50 from 1965 through 1984. This decrease paralleled the decrease in cerebrovascular disease in the community. The decrease in idiopathic unprovoked seizures may be related to a concurrent trend in "silent stroke." Plots and Poisson regression analysis did not show patterns in the incidence of idiopathic unprovoked seizures related to successive birth cohorts. However, significantly lower incidence rates were observed for the 1930-1934 birth cohort, about half that of all others, between the ages of 5 and 54 years.

Interaction of the von Willebrand factor (vWF) with collagen. Localization of the primary collagen-binding site by analysis of recombinant vWF a domain polypeptides

The von Willebrand factor (vWF) mediates platelet adhesion to the vascular subendothelium by binding to collagen, other matrix constituents, and the platelet receptor glycoproteins Ib/IX and IIb/IIIa. Although substantial progress has been made in defining vWF structure-function relationships, there are conflicting data regarding the location of its collagen-binding site(s). Possible collagen-binding sites have been localized in the A1 and A3 domains of vWF. To study the proposed binding sites, we have expressed cDNA sequences encoding the A1 and A3 domains of vWF in Escherichia coli and purified the resulting proteins from bacterial inclusion bodies. In addition, a chimeric molecule containing residues 465-598 of the vWF A1 domain polypeptide (vWF-A1) fused in frame to residues 1018-1114 of the vWF A3 domain polypeptide (vWF-A3) was also expressed. Each of the three recombinant proteins purified as a monomer and contained a single disulfide bond. As previously reported (Cruz, M. A., Handin, R. I., and Wise, R. J. (1993) J. Biol. Chem. 268, 21238-21245), recombinant vWF-A1 inhibited ristocetin-induced platelet agglutination, but did not compete with vWF multimers for collagen binding. In contrast, vWF-A3 inhibited the binding of multimeric vWF to immobilized collagen, but did not inhibit ristocetin-induced platelet agglutination. Metabolically labeled vWF-A3 bound to immobilized collagen in a saturable and reversible manner with a Kd of 1.8 x 10(-6) M. The vWF-A1/A3 chimera was bifunctional. It inhibited vWF binding to platelet glycoprotein Ib/IX with an IC50 of 0.6 x 10(-6) M and inhibited vWF binding to collagen with an IC50 of 0.5-1.0 x 10(-6) M. These results, taken together, provide firm evidence that the major collagen-binding site in vWF resides in the A3 domain.

Incidence of acute symptomatic seizures in Rochester, Minnesota, 1935-1984

We determined the incidence of seizures due to acute CNS insults for residents of Rochester, Minnesota, U.S.A., from 1935 through 1984. The age-adjusted incidence rates for 1955-1984, the period of most complete case ascertainment, was 39.0/100,000 person-years (United States 1970 population as standard). The age-adjusted incidence was considerably higher in men: 52.0 as compared with 29.5 in women. The 3.6% risk of experiencing an acute symptomatic seizure in an 80-year lifespan approaches that of developing epilepsy. The major causes of acute symptomatic seizures were traumatic brain injury, cerebrovascular disease, drug withdrawal, and CNS infections. Each type of acute symptomatic seizure has age, gender, and time period patterns that reflect the occurrence of the underlying cause.

Lecompte procedure for complete transposition of the great arteries with ventricular septal defect and pulmonary stenosis

From December 1988 to February 1993, 19 patients were treated by the Lecompte procedure for complete transposition of the great arteries associated with a ventricular septal defect and pulmonary stenosis. The mean age at operation was 3.1 +/- 0.8 years (mean +/- standard error). This technique consisted of resecting the outlet septum, constructing a tunnel that connected the left ventricle to the aorta, closing the proximal pulmonary arterial stump, pulling the distal pulmonary artery down to the right ventriculotomy site directly, and covering anteriorly with the fixed autologous pericardium. Operative mortality was 5.3%. The mean follow-up was 24.2 +/- 3 months, with no late death. One reoperation was performed because of residual right ventricular outflow tract obstruction. All survivors were studied by echocardiography at intervals of 6 months to 1 year. In all survivors (except for 1 child who underwent reoperation), the estimated pressure gradient between the right ventricle and the pulmonary artery, the structure of the left ventricular outflow tract, left ventricular function, and right ventricular contractility were all satisfactory.

Modified occipital approach to the endolymphatic sac and cochlear aqueduct of the guinea pig

Obliteration of the endolymphatic sac reliably results in endolymphatic hydrops in some animal species. While this procedure is frequently utilized in the study of experimental Meniere's disease, additional information regarding inner ear fluid hydrodynamics can be obtained by obstructing the cochlear aqueduct to eliminate the influence of the cerebrospinal fluid on the perilymphatic compartment of the inner ear. This report describes a modified extradural occipital approach for surgical obliteration of the endolymphatic sac and obstruction of the cochlear aqueduct in the guinea pig. The extradural approach allows direct visualization of the cochlear aqueduct without manipulation or retraction of the dura, sigmoid sinus, or cerebellum. For experimental studies, which require obliteration of both the endolymphatic sac and cochlear aqueduct, this approach provides improved reliability with reduced morbidity and mortality.