Dose rate determination for 125I seeds

Dose rates in water have been determined for the two types of 125I seed currently used in brachytherapy. The need for such determinations became evident when water/air ratios measured with a silicon diode were found to be lower than expected. Extensive measurements using lithium fluoride thermoluminescent dosimeters (TLD's) have been performed in a solid water phantom, at distances from 0.1 to 10 cm from the seed center and at angular increments of 10 degrees, 15 degrees, or 30 degrees within a plane through the seed axis. Dose calibration of the TLD's was accomplished by irradiation in air with 125I seeds of the same type and of strengths traceable to a calibration at the National Institute of Standards and Technology (NIST). Relative calibration of TLD's was monitored by irradiation, in an oven-type x-ray machine, of control dosimeters simultaneously and all dosimeters intercurrently with the 125I irradiations. Values obtained for the dose rate constant, i.e., dose rate per unit air-kerma strength at 1 cm on the transverse axis, were 0.853 and 0.932 cGy h-1 U-1 (1.08 and 1.18 cGy h-1 mCi-1) for the 6711 and 6702 seeds, respectively. Measured data were supplemented with Monte Carlo-calculated relative dose rate data generated using the MORSE code. These calculations used 100 energy groups from 10 to 35.4 keV and involved energy collection bins ranging from 0.025 to 1.2 cm on an edge. Normalized at 1 cm, transverse axis calculated data are not significantly different from measured data (ours or cited literature) at distances either less than 2.5 or greater than 8 cm. Normalized at different distances along the transverse axis, our off-axis calculated and measured distributions agree closely at all angles but differ from literature measured distributions at small (less than or equal to 1 cm) distances and, for small angles, increasingly at larger distances (greater than or equal to 5 cm).

Regional variation in the provision of orthodontic treatment by the hospital services in England and Wales

The regional variation in hospital orthodontic manpower, referral rate, and hospital treatment rate for the 5-15-year-old population was calculated, a marked regional variation was evident. In addition, relevant data from the Consultant Orthodontist Survey of 1985 was also analysed on a regional basis, in order to evaluate any interactions between the above variables and the type of treatment provided, the proportion of referred patients accepted, and treatment priority of patients referred. It was found that the hospital treatment rate was related to the referral rate, no other relevant significant correlations between the variables were detected. Possible explanations are discussed.

Salt taste preferences and perceptions of elderly and young adults

Current research has yielded both support and refutation for the theory that elderly adults have lower taste acuity. The present study compared the perception of and preference for salt in persons 65 years and over and in persons aged 20 to 35 years. The subjects were free-living, had not been hospitalized in the past 12 months, and had never been on a sodium-restricted diet. Salt was introduced in suprathreshold concentrations of 0.3%, 0.5%, 0.7%, and 0.9% in mashed potatoes and chicken broth. The 48 older adults in our study demonstrated higher preferences for the four salt concentrations in the potatoes (p = .0001) and the broth (p = .0004) than did the 53 younger adults. There were no significant differences in the two age groups' abilities to perceive the saltiness of the four concentrations. There were also no significant differences in salt perception among subgroups identified for age, gender, smoking behavior, and denture use. Both groups correctly ranked the concentrations in ascending order. Our study found that taste acuity for salt in older subjects was not different from that of younger adults when suprathreshold concentrations of salt in mashed potatoes and chicken broth were used as stimuli.

An analysis of retrospective data concerning the provision of orthodontic treatment by the community dental services

The distribution of both community orthodontic and dental officer manpower has been reviewed, and both exhibit an unequal regional variation. The amount of orthodontic treatment provided was calculated, and expressed as a treatment rate and percentage of fixed: removable appliances fitted. There was a marked regional variation in the form of appliance utilized, and there was a significant relationship between community orthodontic manpower and the relative use of fixed appliances. However, the treatment rate was not related to the manpower distribution. The data collected, by the Department of Health, on the provision of orthodontic treatment was found to have some limitations in its usefulness for epidemiological purposes.

Regional distribution of cholecystokinin messenger RNA in rat brain during development: quantitation and correlation with cholecystokinin immunoreactivity

The regional distribution of CCK-octapeptide (CCK) and CCKmRNA were studied in parallel in rat brain during development in order to characterize changes in gene expression in different structures at different periods of development and to determine whether differential regulation of translation and peptide turnover occurs, by correlating peptide and mRNA levels. CCK was characterized by Northern blot analysis. Methods were developed for quantitation of CCKmRNA by in situ hybridization (ISH) and compared with results obtained by slot blot analysis. Analysis of CCKmRNA by ISH showed that CCKmRNA was abundant in cerebral cortex, hippocampus, dentate gyrus, thalamus, inferior colliculus and periaqueductal grey in keeping with the high concentrations of CCK-like immunoreactivity in cell bodies located in these regions. Quantitation of CCKmRNA by computerized densitometric image analysis by reference to [35S]brain paste standards gave a similar pattern to that obtained by slot blot analysis of regional RNA extracts. Distinctive patterns of CCK development were seen. In cerebral cortex and hippocampus, a marked increase in peptide and mRNA levels was found from day 1 which showed a steady increase up to adult levels. However, in the thalamus, the highest levels of mRNA and peptide were reached at a much earlier stage, generally by 14d. In contrast, inferior and superior colliculus showed a delayed onset of peptide expression.

Comparison of perceived needs of family members between registered nurses and family members of critically ill patients in intensive care and neonatal intensive care units

Using the Norris and Grove (1986) questionnaire of perceived needs of families of critically ill patients, 11 registered nurses working in the neonatal intensive care unit and 19 registered nurses working in the intensive care unit of two mid-northern community hospitals provided their perceptions of family needs. Their responses were compared with responses of family members of patients in the intensive care unit (n = 25) and the (n = 24). Results suggest that regardless of unit, registered nurses' perceptions of family needs are congruent. Family members collectively and by unit ranked their needs consistently higher and in some areas differently than did the registered nurses.

Galactic cosmic radiation exposure and associated health risks for air carrier crewmembers

The dose equivalent to air carrier crewmembers from galactic cosmic radiation was estimated for each of 32 nonstop flights on a variety of routes to and from, or within, the contiguous United States. Flying times were from 0.4 to 13 hours. The annual dose equivalents received on the flights ranged from 0.2 to 9.1 mSv (20 to 910 mrem), or 0.4 to 18% of the recommended annual limit for occupational exposure of an adult. We reviewed some of the characteristics of galactic and solar cosmic radiation and provided example calculations for estimating radiation-induced risks of fatal cancer, genetic defects and harm to an embryo or fetus. The estimated increased risk of dying from cancer because of galactic radiation exposure received during 20 years of flying ranged from 0.1 to 5 in 1,000. For the adult U.S. population the risk of dying from cancer is about 220 in 1,000.

A comparison of the effects of tenoxicam and piroxicam on grip strength in patients with rheumatoid arthritis

Ten patients were recruited for this randomised double-blind pilot study to compare the efficacy and tolerance of tenoxicam 20 mg daily and piroxicam 20 mg daily in patients with rheumatoid arthritis (RA). The change in grip strength over an eight week study period was the primary efficacy variable and measurements were made using a digital pinch/grip analyser (MIE Medical Research Ltd.). There were no significant treatment differences in the change in grip strength (p greater than 0.2), although greater improvements in all efficacy parameters measured were achieved for patients receiving tenoxicam than those receiving piroxicam. Both treatments were well tolerated with few adverse events reported. Further studies with more patients are required to adequately assess whether there are any differences between treatments.

A randomized, double-blind study to compare tenoxicam with sustained release indomethacin in osteoarthritic patients treated in general practice

A total of 144 patients were recruited for this randomized, double-blind study to compare the efficacy and tolerance of tenoxicam and sustained release indomethacin in patients with osteoarthritis. The results show that 20 mg/day tenoxicam is equal in efficacy to, and significantly better tolerated than, 75 mg/day sustained release indomethacin. Patients receiving tenoxicam recorded significantly better global tolerance ratings (P = 0.042) and fewer adverse events than those receiving indomethacin.

Solid cancer risk after treatment of Hodgkin's disease

We pooled the data from seven studies of second cancer risk after treatment of Hodgkin's disease (HD) and estimated the relative risks (RR) of solid cancers (SC) for the following two treatment groups: (1) radiotherapy, with or without chemotherapy; and (2) chemotherapy alone. For all treatment groups combined, the RR of SC was 2.1 (95% confidence limits: 1.8 to 2.4). In the radiotherapy group, statistically significant RR were found for SC for all anatomic sites (RR: 2.2; 95% confidence limits: 1.9 to 2.6) and for SC of the bones and joints (RR: 20.0), soft tissues (RR: 18.3), non-HD lymphomas (RR: 8.1), melanomas of the skin (RR: 6.7), buccal cavity and pharynx (RR: 4.1), nervous system (RR: 3.6), respiratory system (RR: 2.5), and digestive system (RR: 1.8). In the chemotherapy alone group, none of the RR differed significantly from unity, and the RR for SC of all sites was 1.1 (95% confidence limits: 0.5 to 1.9). The average duration of follow-up for patients with chemotherapy was shorter than the duration of follow-up for patients with radiotherapy. This may explain the general absence of elevated RR after chemotherapy.

Identification of Escherichia coli from shellfish and related environments by automicrobic system

A total of 463 fecal coliform positive isolates obtained from shellfish and related samples gave typical Escherichia coli IMViC reactions. E. coli identifications for 458 (99%) of these isolates were confirmed using a combination of the Automicrobic System (AMS) and the API 20E system (reference system). The AMS (test system) identified 433 isolates as E. coli; the remaining 25 (5%) isolates were identified as E. hermanii by the test system and as E. coli by the reference system. Additional tests performed on the isolates identified as E. hermanii confirmed those AMS identifications to be incorrect.

Effects of HIV infection, perceived health and clinical status on a cohort at risk for AIDS

Data from a general population sample of 621 healthy homosexual men are used to evaluate the social and emotional effects of HIV antibody status, clinical signs detected by medical examination, and subjectively perceived symptoms. Participants are unaware of their serologic status at the time of data collection, thus allowing the effects of the virus to be separated from reactions to the knowledge of serologic status. The data show that seropositivity for HIV is not associated with elevated levels of social or emotional impairment. Clinical signs lead to impairment in baseline data, but these effects do not persist at a second wave. This weakening suggests that the effects are mediated by psychological pathways rather than biologic ones. This suspicion is confirmed in further analyses, which show that the effects of clinical signs are mediated by subjectively perceived symptoms. These results show that neither social nor emotional impairment is likely to be a prodromal sign of HIV infection in otherwise healthy homosexual men. The substantial levels of distress found among these men is more directly influenced by psychological determinants than biologic ones. This suggests that physicians should be aware of the psychological toll imposed on gay men who develop health problems in the current atmosphere of uncertainty regarding risk of AIDS.

The triage role of fine needle aspiration biopsy of palpable breast masses. Diagnostic accuracy and cost-effectiveness

A total of 219 fine needle aspiration (FNA) biopsies of the breast were performed during the period 1983 to 1985 at a tertiary medical center. The series consisted of 215 women (98.2%) and 4 men (1.8%), with an are range of 14 to 90 years (mean of 46.5 years). Histologic confirmation (93 cases) or clinical follow-up for up to two years was obtained. The sensitivity of the FNA procedure was 82.2%, its specificity was 98.8%, and the overall efficiency of the test was 95.4%. The false-negative rate was 4.4%, with no false-positive diagnoses for the primary diagnosis of breast carcinoma. We have found that one of the major advantages of FNA biopsy is that it lowers costs by allowing the surgeon to triage which patients should have an outpatient excisional biopsy under local anesthesia and which patients should have a one-stage inpatient procedure with frozen section confirmation. For this triage role, suspicious diagnoses (3.2%) were included in the positive group and atypical (1.8%) and insufficient diagnoses (6.8%) in the negative group. Taking into account the FNA biopsy cost of $75, the procedure resulted in a savings per case of $262 over the cost that would have occurred if all cases had had routine inpatient biopsy and $154 per case over the cost that would have occurred with routine outpatient biopsy of all cases. Our results indicate that FNA breast biopsy is a diagnostically accurate and economical triage procedure, even when followed by an excisional or frozen-section biopsy for confirmation. The use of FNA biopsy could be expanded to a greater number of medical centers and decrease the potential for false-positive diagnoses by combining FNA biopsy with frozen-section confirmation.

Changes in serum lipid concentrations during first 24 hours after myocardial infarction

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Prevalence of smokeless tobacco use in Pitt County, North Carolina

The purpose of this study was to estimate the prevalence of smokeless tobacco use in the largest tobacco-producing county in the United States. A 1-in-100 systematic random telephone sample was taken from the county telephone directory. A total of 280 complete questionnaires were obtained. Results indicate that .40 +/- .042 [p +/- SE(p)] males and .09 +/- .024 of females use smokeless tobacco. The point prevalence for the total population was estimated to be .15.

Cytologic results of fine-needle aspiration biopsies of the central nervous system

The cytologic results of 34 fine-needle aspiration (FNA) biopsies of the central nervous system (CNS) are reported. There were 31 intraoperative biopsies performed at the time of craniotomy. All the cases were diagnosed using direct smear preparations stained with Papanicolaou and Diff-Quik (Harleco, NJ) stains. The sensitivity of the procedure was 90.7%, specificity 100%, positive predictive value 100%, and efficiency of the test of 91%. There were no false-positive diagnoses and three false-negative diagnoses. This study attests to the diagnostic accuracy of FNA cytologic examination of the central nervous system. Statistical analysis of the few previous FNA biopsy series of the CNS are presented. Review of the indications, advantages and complications of CNS needle biopsy are discussed. This report supports the role of fine-needle aspiration cytology in the evaluation of CNS lesions. With recent developments in radiologic imaging, especially ultrasound and computed tomography (CT) using stereotactic guidance, specimens can be obtained for cytologic diagnosis using thinner needles. Excellent diagnostic accuracy can be obtained, as pathologists gain greater familiarity with interpreting FNA biopsy material. Other advantages of FNA biopsy of the central nervous system include the low morbidity and mortality of the procedure and the ability to perform the biopsy through a burr hole under local anesthesia and thereby decrease hospitalization time and cost.

Monte Carlo dosimetry for 125I and 60Co in eye plaque therapy

Monte Carlo calculations of radiation dosimetry using MORSE code are performed for 125I and 60Co point sources in a cylindrical head phantom that simulates the geometry of eye plaque therapy for choroidal melanoma. We obtain the dose variation in the eye at submillimeter intervals over distances as close as 1 mm and up to 2.5 cm from the source. The calculations for 125I are performed for the phantom media of water, protein, and a homogenized protein-water mixture simulating the composition of the eye. Relative dose functions for 125I for these phantom media are fitted to second-degree polynomials. Agreement is found with published results. The relative dose function for 60Co at eye position in the water head phantom is fitted to a third-degree polynomial and compared with that for 60Co at the center of a large water sphere. A boundary effect due to the head phantom-air interface on the dose distribution for 60Co is demonstrated. The dose falloff with distance is faster for the eye geometry compared with the bulk geometry. We also show that the relative dose distributions within the tumor are comparable for 125I and 60Co by comparing their relative dose functions. This result is consistent with the success of clinical trials of large melanoma treatments with 125I plaques.

Detection of two viral genomes in single cells by double-label hybridization in situ and color microradioautography

Double labeling and color microradioautography were used in a new method of hybridization in situ to identify different genes in individual cells. The method is based on the unequal penetration of 3H and 35S into two layers of nuclear track emulsion separated by a thin barrier film. Hybridization of a 35S-labeled probe specific for one kind of gene results in silver grains over cells in both layers of emulsion; a 3H-labeled probe for a second gene provides grains only in the first layer of emulsion. Silver grains are converted to magenta-colored grains in the first layer and to cyan-colored grains in the second to facilitate enumeration of grains in each layer. This technique should be widely applicable in analyses of differential gene expression in single cells or in discrete populations of cells.

Can a calcaneal morphologic index determine the degree of osteoporosis?

The proposal that a scoring system of the radiographic trabecular patterns of the os calcis could be related to degree of osteoporosis was tested. The technique fails as it showed no correlation with actual bone density determined by a Compton scatter technique and because of a low level of observer concordance. Possible reasons for the poor performance of the index developed in India when applied to North Americans are discussed.

Glucose affects in vitro maturation of fetal rat islets

Fetal pancreatic islets (21.5 days old) were cultured in RPMI 1640 containing either 2.8 or 11.1 mM glucose for 7 days. After the 7-day culture period, islets cultured in 2.8 mM glucose demonstrated a minimal first phase of insulin secretion in response to acute glucose stimulation, whereas islets cultured in 11.1 mM glucose demonstrated a biphasic insulin secretory pattern. Islets cultured in 11.1 mM glucose initiated insulin secretion at 4.4 +/- 0.1 mM glucose and plateaued at 11.6 mM glucose when exposed to a linear gradient. In addition, culture in 11.1 mM glucose increased DNA content (P less than 0.01) and [3H]thymidine incorporation (P less than 0.05) in fetal islets. However, ultrastructural morphometric analysis indicated that the actual number of beta-cells within islets cultured in either 2.8 or 11.1 mM glucose did not increase. The insulin contents of islets cultured in 2.8 and 11.1 mM glucose were 0.46 +/- 0.06 and 1.14 +/- 0.10 mU/islet, respectively. During subsequent glucose stimulation, islets cultured in 2.8 and 11.1 mM glucose released 3% and 5.6% of their total insulin content, respectively. Ultrastructural morphometric analysis indicated that 11.1 mM glucose stimulated an increase in the volume of individual beta-cells, i.e. hypertrophy. The hypertrophy of beta-cells within islets cultured in 11.1 mM glucose resulted in a concomitant increase in islet volume. Finally, the hypertrophy of beta-cells within islets cultured in 11.1 mM glucose was a result of increased volumes of mitochondria, secretory granules, and, to the greatest extent, endoplasmic reticulum. These findings indicate that glucose is a potent factor in the maturation of cultured fetal rat islets.

The relation of age to the thickness of the interventricular septum, the posterior left ventricular wall and their ratio

We obtained echocardiographic measurements of interventricular septal and posterior left ventricular wall thickness in 100 apparently normal subjects in whom there was no evidence or history of coronary artery disease, hypertension or prolapsing mitral valve. Subjects were divided into five age groups of 20-29, 30-39, 40-49, 50-59 and 60-70 years and there were 20 subjects in each group. Measurements of interventricular septum and posterior left ventricular wall thickness were made in each subject at both mitral and sub-mitral levels at the time of Q wave inscription, and the measurements were related to body surface area. The interventricular septum increased from a median of 8.3 mm in the age group 20-29 to 11.2 mm in the group 60-70, whereas the posterior left ventricular wall increased from 7.5 mm to 9.8 mm. The difference in the medians between the groups 20-29 and 60-70 was statistically significant for both interventricular septum and posterior left ventricular wall (P less than 0.02). Our data showed that interventricular septal, posterior left ventricular wall thickness measurements and their ratio should be related to age in order to assess their significance.

Metabolic basis of the species difference to aflatoxin B1 induced hepatotoxicity

Primary metabolism of aflatoxin B1 by the liver microsomal enzymes from a range of animal species showed both quantitative and qualitative differences. Quail was shown to have the most rapid metabolism of aflatoxin B1. The major product of metabolism in this case was found to be aflatoxin B1-8,9-dihydrodiol suggesting that the quail microsomes produced high levels of the proposed reactive intermediate aflatoxin B1-8,9-epoxide. Using this system to generate the epoxide, the ability of the cytosol prepared from each species to conjugate epoxide with reduced glutathione was investigated. Large differences in ability to conjugate were observed ranging from 0 to 72% for quail and mouse respectively. Differences in both primary and secondary metabolism of AFB1 were noted between male and female Fischer 344 rats.

Protection of the myocardium during ischemic arrest. Dose-response curves for procaine and lignocaine in cardioplegic solutions

The dose-response curve of procaine or lignocaine (lidocaine) added to the St. Thomas' Hospital cardioplegic solution was investigated with an isolated working rat heart preparation. In the absence of any cold cardioplegic protection, hearts failed to recover after as little as 30 minutes of ischemia. A single infusion (20 degrees C) of the basic St. Thomas' Hospital cardioplegic solution allowed hearts to recover to 60% or more of their preischemic control aortic flow after a 120 minute period of ischemia. Addition of procaine to the cardioplegic solution either increased or reduced the apparent protective properties of the solution with a bell-shaped dose-response curve being obtained. The optimum procaine concentration was 0.05 mM/L. At this concentration the protection afforded by the St. Thomas' Hospital solution was increased by up to two thirds. Substitution of lignocaine for procaine resulted in a similar dose-response curve with its optimum also at 0.05 mM/L. If a similar optimum exists for the human heart, the doses in current clinical use would appear to be too high. These results argue for determining the dose-response characteristics of all substances used in cardioplegic solutions.

Flow-cytogenetics. II. High-resolution ploidy measurements in human fibroblast cultures

high-resolution flow-cytometric measurements of ethidium bromide/mithramycin-stained human fibroblast cultures reveal discrepancies between fluorescence pulse-height distributions and genome size as a function of cell strain, culture conditions, culture age, and proliferative stage. These discrepancies were quantitatively assessed by (1) evaluation of the variation of the widths of the 2c fluorescence pulse-height histogram peaks, (2) comparisons between sample to standard fluorescence ratios of 45,XO and 49,XXXXY cell strains, and (3) comparison of fluorescence intensities among cell populations of identical genome size but differing degrees of chromatin condensation (mitotic vs. nonmitotic cells of diploid and tetraploid cell strains). As in our previous studies with lymphocytes, our results suggest caution in equating fluorescence intensity with "DNA content" in flow measurements of nonhomogeneous cell populations. Conditions of cell culture and sample preparation must be standardized in order to compare "DNA content" differences by flow techniques. Remaining sources of variation presently limit detection to differences in DNA content of greater than 2%.

Congenitally bicuspid aortic valves. Clinicogenetic study of 41 families

The families of 41 patients with surgically proved isolated bicuspid aortic valves were examined. There were 275 first degree relatives of whom 220 were living, and 188 (85.5%) of these were examined. Seven first degree relatives were found to have aortic valve disease, and in a further 11 there was 'doubtful' evidence of bicuspid aortic valves. In 6 families there was more than 1 affected member and in an additional 7 families there was 1 or more 'doubtful' first degree relative. The minimum family incidence was therefore 14.6 per cent, or 31.7 per cent if 'doubtful' cases were included. The inheritance is most probably multifactorial, but occasionally the condition may occur as an autosomal dominant. The difficulties of diagnosing bicuspid aortic valves before the development of obstruction of left ventricular outflow were encountered and are discussed. The association of a bicuspid aortic valve with asymmetric septal hypertrophy, hypertrophic cardiomyopathy, and Marfan's syndrome was also noted.

Cross-linking studies of the self-association properties of apo-A-I and apo-A-II from human high density lipoprotein

The state of self-association of the apoprotein components of human high density lipoprotein have been studied by use of the cross-linking reagent dimethyl-suberimidate. Analusis of the cross-linked products was carried out by soduim dodecyl sulfate-gel electrophoresis and by agarose column chromatography in 6 M guanidine hydrochloride. Apo-A-I was found to exist as a monomer at low concentration, but associates to tetrameric and pentameric forms at concentrations of 0.5 mg/ml or higher. The self-association was found to be ionic strength-dependent, with association promoted by the presence of salt. Apo-A-II was also found to associate, but the major oligomeric form observed was dimeric (Mr = 34,000), and the association was less dependent on ionic strength than for apo-A-I. Cross-linking in the presence of various concentrations of guanidine hydrochloride showed that apo-A-II self-association persisted at higher concentrations of the denaturant than for apo-A-I. Studies of the effect of temperature demonstrated that the self-association of both proteins was diminished at temperatures above 30 degrees C. Recombination of apo-A-II with phospholipid resulted in the formation of particles which yielded primarily trimers upon cross-linking. This suggests that phospholipid binding causes major reorganization of the self-associated forms of apo-A-II.

Monte Carlo calculations of the energy response of lithium dosemeters to high energy electrons (less than 30 MeV)

Monte Carlo calculations of the energy response of LiF dosemeters have been carried out to help resolve the discrepancy between the measurements of Holt, Edelstein and Clark (1975) and those of Paliwal and Almond (1975) and others. It is concluded that the assumptions used by Holt et al. are largely responsible. They assume, in converting energy deposition in an air-filled ionization chamber to energy deposition in water, that as electrons penetrate a medium they are monoenergetic and the energy is given by Harder's expression (ICRU 1972). The assumption gives poor results as the stopping power for electrons in air is strongly energy dependent, and the energy spectrum has been significantly broadened. The Monte Carlo calculations are also used to criticize the electron cavity theories of Almond and McCray (1970), Burlin, Snelling and Owen (1969) and Holt et al. (1975), and to suggest as an alternative a slightly modified version of the Bragg-Gray theorem.

Long-term hemodialysis for patients over 50

Hemodialysis can hodl end-state renal failure at bay and enable patients to lead a relatively normal life-regardless of their age. In a 10 year retrospective study of 574 patients, the 154 patients over 50 had about the same survival rates as younger persons for the first three years of dialysis. After that, the older patients had higher mortality. Patients who dialyzed themselves at home-with a relative or friend to help-had much better results than those who were dialyzed at the center. This in part reflects the selection process, since patients with severe medical problems usually weren't allowed to try self-dialysis. Older patients did particularly well on home dialysis, which was attributed to their maturity and dependability. Older patients with cardiac instability may require carefully monitored dialysis at the center and frequent blood transfusions. In general, though, patients over 50 needed fewer transfusions and fewer days in the hospital than younger patients.

Ebstein's anomaly. Genetic study of 26 families

The families of 26 patients with Ebstein's anomaly were examined. There were 120 first-degree relatives, 100 of whom were living, and 93 of these were examined. Information was available on 14 of the 20 who had died. No case of Ebstein's anomaly was found among the first-degree relatives, but 2 had ventricular septal defects and another, who died at 7 months, was said to have had congenital heart disease. In more distant relatives there were 6 with congenital heart disease, including 2 with ventricular septal defects and 2 with Fallot's tetralogy.

Association of secundum atrial septal defect with abnormalities of atrioventricular conduction or left axis deviation. Genetic study of 10 families

A genetic analysis was made of 10 families in which the propositi had a secundum atrial septal defect associated with abnormal atrioventricular conduction (first, second, or third degree heart block) or unexplained left axis deviation or a combination of these conduction disturbances. Diagnostic information was available on 51 (81%) of the first degree relatives. Three of the families appeared to be examples of a new syndrome which, with variable expression, was inherited as a non-sex-linked autosomal dominant. The main features were a secundum atrial septal defect; disease of the conducting tissue, which in some cases was progressive; unexplained left axis deviation; and unexpected death. These families did not seem to be examples of the Holt-Oram syndrome, for the upper limbs were clinically and radiologically normal in the 19 members examined. The importance of recognizing this syndrome is the occurrence of progressive disease of the conducting tissue and the risk of sudden death. When, therefore, unexplained left axis deviation or prolonged atrioventricular conduction is found in association with a secundum atrial septal defect all available relatives should be examined. In the remaining seven families there was only one affected first degree relative out of 39 examined. He was the son of one of the propositi and had paroxysmal coronary sinus rhythm with an intact atrial septum.