Oral vinorelbine (Navelbine) in the treatment of advanced non-small cell lung cancer: a preliminary report

Vinorelbine (Navelbine; Burroughs Wellcome Co, Research Triangle Park, NC; Pierre Fabre Médicament, Paris, France) is a novel semisynthetic vinca alkaloid with antitumor activity in non-small cell lung cancer. An oral preparation of this drug is under investigation and was tested in a multicenter phase II study in patients with stage IV measurable or evaluable non-small cell lung cancer. The initial vinorelbine dose was 100 mg/m2/wk (80 mg/m2/wk for patients with prior radiotherapy). Following an initial 37% incidence of grade 3 or 4 neutropenia, the dose was reduced by 40 mg/dose. Nausea, vomiting, diarrhea, and mucositis were other frequently observed toxicities. A preliminary analysis indicated a response rate of 14%, suggesting activity of this drug when administered orally.

The impact of strategic conflict on the management of information technology in a hospital

This case study examines the management of information technology in a public teaching hospital. The technology is divided into two major classes: central, mainly administrative systems; and local clinical systems. This split is an outcome of the strategic conflict between the goals of efficiency and effectiveness as pursued by administrators and clinicians respectively. Without resolving this conflict it would be very difficult to develop an integrated information system for this hospital.

Dual Alu polymerase chain reaction primers and conditions for isolation of human chromosome painting probes from hybrid cells

A method for rapid and efficient production of chromosome- and chromosome-region specific probes for fluorescent in situ hybridization (FISH) detectable by simple fluorescent microscopy is described. The procedure is based on simultaneous use of two inter-Alu-polymerase chain reaction (PCR) primers for extraction of highly heterogeneous human DNA from interspecific somatic cell hybrids containing the chromosome regions of interest. Probes so produced do not hybridize to centromeric sequences and simultaneously band the target chromosomes, making them useful for unambiguous identification of chromosomal elements and breakpoints associated with cancer.

Tumor specific response to photodynamic therapy

The exact mechanism by which photodynamic therapy (PDT) causes tumor destruction has not been elucidated. Early reports indicated that PDT causes direct cellular effects probably mediated by unstable oxygen species, resulting in cellular oxidation and death. More recently, PDT effects on tumor blood flow have been implicated, and there are questions as to whether the PDT response is specific to tumor tissue. Rats were implanted with a window chamber containing either a mammary adenocarcinoma or a piece of inert surgical sponge. After growth of the tumor was ascertained, all rats were given 5 mg/kg Photofrin intraperitoneally, and then were irradiated with 630 nm light 24 hours post-injection. Caliper thickness and reflectance measurements were performed before and after irradiation; all animals were sacrificed 72 hours post-PDT and the chambers submitted for histologic analysis. Animals implanted with tumors demonstrated marked edema of the chamber with an associated decrease in reflectance. No edema response was noted in the chambers containing inert sponge, or in any controls. Nonselective PDT effects (characterized by a marked foreign body response) in chambers containing sponge was not seen. Histologic analysis of treated specimens corroborate the above data.

Human immunodeficiency virus (HIV) seroprevalence surveys

The seroprevalence surveys being conducted in the Kansas City area have to date tested 15,778 persons and resulted in 85 seropositive HIV tests. The sexually transmitted disease (STD) surveys and women's surveys fall in the lowest quartile of the combined national surveys. The drug treatment (IVDU) survey data were comparable to the median national seroprevalence of 3.8%. Seroprevalence rates in the STD surveys were 41 times that of women's surveys, and the IVDU surveys were 104 times that of the women's surveys. Based on three years of data from clinics with stable populations presenting for treatment, no trends in the demographics of those being found seropositive were identified to be statistically significant. This lack of trends has been presented as the normal findings of surveys nationally. The data does not show an acceleration of new infections based on seropositives being identified in the survey sites.

Soluble dietary fiber and cholesterol influence in vivo hepatic and intestinal cholesterol biosynthesis in rats

Ninety-six male Sprague-Dawley rats were randomly assigned to eight dietary treatments. Rats were fed, with ad libitum access, diets containing 10% dietary fiber as cellulose (control), pectin, psyllium or oat bran with or without 0.3% added cholesterol for 3 wk. Among cholesterol-fed rats, liver total cholesterol was significantly lower in rats fed diets supplemented with either pectin or psyllium compared with those fed cellulose. In contrast, rats fed oat bran with cholesterol had significantly higher liver cholesterol concentrations compared with cellulose-fed animals. Liver total lipid concentrations were significantly lower in groups fed pectin and psyllium with or without dietary cholesterol compared with cellulose-fed controls. Pectin feeding with or without dietary cholesterol significantly lowered plasma total cholesterol compared with cellulose feeding. Oat bran had no effect on plasma total cholesterol compared with control diets. Hepatic sterol synthesis was significantly greater for animals fed soluble dietary fibers compared with those fed cellulose, but the effect on intestinal sterol synthesis was less pronounced.

Inversion of chromosome 16 with the Philadelphia chromosome in acute myelomonocytic leukemia with eosinophilia. Report of two cases

Two cases are described with the rare combination of inv(16)(p13q22), strongly associated with acute myelomonocytic leukemia with eosinophilia, M4Eo, and the Philadelphia translocation, t(9;22)(q34;q11), hallmark of chronic myeloid leukemia (CML) and rarely found, (less than 1%), in acute nonlymphocytic leukemia. The patients were: case 1, a 9-year-old girl presenting with a white blood cell count (WBC) 42 x 10(9)/L with 32% blasts and bone marrow with blasts and eosinophil precursors consistent with M4Eo, and case 2, a 25-year-old man with WBC 34.7 x 10(9)/L with 13% blasts and bone marrow with features of M4Eo and basophilia. Both patients achieved remission but died following bone marrow transplantation in first remission (case 1) or in relapse (case 2). Cytogenetic findings were: case 1, at diagnosis, 46,XX,inv(16)(p13q22)(21)/46,XX,t(9;22) (q34;q11),inv(16)(8)/46,XX(10), and case 2, at diagnosis, 46,XY,t(9;22) (q34;q11),inv(16)(p13q22) (16) and in remission, 46,XY,t(9;22)(q34;q11) (1)/46,XY (24). Investigation of the breakpoint on 22 in case 1 with Southern blotting and the polymerase chain reaction demonstrated the presence of a p190 mRNA and a breakpoint typical of acute leukemia. Thus a diagnosis of M4Eo was supported by clinical and cytogenetic sequelae in each case; the Ph in case 1 was apparently secondary to inv(16), in case 2 the Ph probably preceded inv(16) in the etiology of the leukemia.

The postoperative cardiac infant: physiologic basis for neonatal nursing interventions

The care of the postoperative cardiovascular neonate is complex and multifaceted. A comprehensive understanding of physiology, pathology, and appropriate interventions is necessary for a successful outcome. The neonatal nurse plays a pivotal role in the collaborative management of these neonates to support delivery of quality care.

A phase I trial of taxol given by a 6-hour intravenous infusion

Taxol is a unique mitotic inhibitor that has entered phase II investigation. Phase I studies demonstrated hypersensitivity reactions that were related to the cremophor vehicle and to the rate of drug infusion. As a result, the time span of intravenous (IV) infusion of taxol was routinely prolonged to 6 hours or beyond, and premedication with diphenhydramine, dexamethasone, and cimetidine was initiated. Early studies showed antitumor activity, especially against malignant melanoma and ovarian carcinoma. This phase I trial was performed giving taxol, as a 6-hour IV infusion every 21 days, without premedication. The purpose was to study the necessity of premedication and its impact on toxicity and pharmacokinetics. Thirty-one patients received 64 assessable courses of taxol. One patient had a hypersensitivity reaction, which was easily controlled using routine measures. Myelosuppression was dose-limiting, but sporadic, with two fatalities due to sepsis. Nonhematologic toxicity was of grade 1 and 2 except for one patient with grade 3 mucositis and two patients with grade 3 neuropathy. The neuropathy consisted of reversible painful paresthesias, requiring discontinuation of drug in two patients. Four partial responses were seen (three in patients with non-small-cell lung cancer, one in a patient with adenocarcinoma of unknown primary). Pharmacokinetic values were consistent with those previously reported. The occurrence of myelosuppression or neurotoxicity appeared to be associated with the area under the concentration x time curve (AUC) of taxol. The recommended phase II starting dose on this schedule is 225 mg/m2. Taxol merits broad investigation at the phase II level.

Human immunodeficiency virus (HIV) sero-prevalence in sexually transmitted disease clinic populations

Two HIV sero-prevalence surveys conducted during 1989 in public sexually transmitted disease clinics in the Kansas City SMSA tested 1,561 males and 1.043 females. There were 23 sero-positive males; no sero-positive females. The rate for males using the Missouri clinic was nearly triple that of males using the Kansas clinic. Among males the sero-prevalence rate for white males was 8.4 times that for black males. Of the 14 HIV sero-positive males for whom risk factor information was available, 12 were gay or bisexual and two were heterosexual intravenous drug users.

Low urinary chiro-inositol excretion in non-insulin-dependent diabetes mellitus

BACKGROUND AND METHODS

Inositol is a major component of the intracellular mediators of insulin action. To investigate the possible role of altered inositol metabolism in non-insulin-dependent diabetes mellitus (NIDDM), we used gas chromatography and mass spectrometry to measure the myo-inositol and chiro-inositol content of urine specimens from normal subjects and patients with NIDDM: The study subjects were whites, blacks, and Pima Indians. The type of inositol and its concentration in insulin-mediator preparations from muscle-biopsy specimens from normal subjects and diabetic patients were also determined.

RESULTS

The urinary excretion of chiro-inositol was much lower in the patients with NIDDM (mean [+/- SE], 1.8 +/- 0.8 mumol per day) than in the normal subjects (mean, 84.9 +/- 26.9 mumol per day; P less than 0.01). In contrast, the mean urinary myo-inositol excretion was higher in the diabetic patients than in the normal subjects (444 +/- 135 vs. 176 +/- 46 mumol per day; P less than 0.05). There was no correlation between chiro-inositol excretion and the age, sex, or weight of the diabetic patients, nor was there any correlation between urinary chiro-inositol and myo-inositol excretion in either group. The results were similar in a primate model of NIDDM, and chiro-inositol excretion was decreased to a lesser extent in animals with prediabetic insulin resistance. chiro-Inositol was undetectable in insulin-mediator preparations from muscle-biopsy samples obtained from patients with NIDDM: Similar preparations from normal subjects contained substantial amounts of chiro-inositol. Furthermore, the chiro-inositol content of such preparations increased after the administration of insulin during euglycemic-hyperinsulinemic-clamp studies in normal subjects but not in patients with NIDDM:

CONCLUSIONS

NIDDM is associated with decreased chiro-inositol excretion and decreased chiro-inositol content in muscle. These abnormalities seem to reflect the presence of insulin resistance in NIDDM:

Scanning laser Doppler Technique for velocity profile sensing on a moving surface

A scanning laser Doppler technique based on Chebyshev demodulation has been developed for the rapid measurement of spatially distributed velocity profiles. Scan frequencies up to 100 Hz can be used over scan lengths up to 270 mm. The Doppler signals are processed in the conventional manner using a frequency counter. The analog velocity output from the counter is post-processed to obtain the velocity profile. The Chebyshev demodulation post-processing technique for processing the velocity signals from solid surfaces has been introduced. The data processing technique directly yields the spatial velocity distribution in approximate functional form through frequency domain analysis of the scanning LDV velocity output. Results from a rotating disk setup are presented to illustrate the concept.

Perceived learning needs of family physicians in british columbia

To determine family physicians' preferences for time, location, instructional format, and topics, the Division of Continuing Medical Education at the University of British Columbia conducted a survey, in which 1200 questionnaires were mailed to a stratified, proportional random sample of the 3270 general practitioners in the province, the stratifications being urban or rural and decade of graduation. A return rate of 61% yielded 648 usable questionnaires, which exceeds the sample required for analysis with no stratifications. Most popular days for involvement in continuing medical education were Fridays and Saturdays in the months of February, March, October, and November. Common skin disorders and hypertension headed the list of most relevant topics for the whole group and for the urban stratification. Hypertension was superseded by eye emergencies in the rural stratification.

The int-1 proto-oncogene is transcriptionally activated during neuroectodermal differentiation of P19 mouse embryonal carcinoma cells

We have used the P19 line of mouse embryonal carcinoma (EC) cells to initiate studies on the putative role of the int-1 proto-oncogene during neuronal differentiation. P19 cells are induced to differentiate into neurons, astrocytes and fibroblast-like cells following exposure to retinoic acid (RA). Treatment of the same P19 cells with dimethyl sulfoxide (DMSO) leads to differentiation into mesodermal derivatives, including skeletal and cardiac muscle. Northern blot analysis showed that int-1 RNA was not present in the EC cells but appeared 48 h after RA exposure and could be detected for at least the next 8 days. No int-1 RNA was detected in P19 cells induced to differentiate with DMSO. Nuclear run-on transcription assays showed that int-1 expression in RA-treated P19 cells was induced at the transcriptional level. Immunofluorescent staining with an antibody directed against an int-1 peptide identified immunoreactive material in cytoplasmic granules of fibroblast-like cells in RA-treated P19 cultures. Thus the P19 cell line is a suitable experimental system to study int-1 gene expression and function during neuroectodermal development.

Expression of the human cardiac actin gene in differentiating rat skeletal myoblasts

The human cardiac-actin (CH-actin) gene was transfected into rat L6 skeletal myoblasts and stable transformants were isolated. The level of the CH-actin transcript varied between clones but changed little during the differentiation of myoblasts into multinucleate myotubes. Chimeric genes were constructed in which the CH-actin promoter, first non-coding exon (44 bp), and first intron (about 700 bp) were linked to the Herpes simplex virus thymidine kinase (tk) coding region. Clones of L6 cells transformed with these chimeric genes contained variable levels of actin-tk mRNA which changed little during differentiation. Thus, the activity of the CH-actin promoter appeared not to be up-regulated upon differentiation of myoblasts into myotubes. In clones of cells expressing the actin-tk mRNA, the TK protein was not detected in myoblasts but appeared in differentiating multinucleate myotubes. We interpret these results as suggesting developmentally regulated translation of the actin-tk mRNA. Since the first 44 nucleotides of the actin-tk mRNA were derived from the 5'-untranslated region of the CH-actin mRNA. These experiments suggest that translation of the actin-tk mRNA may be controlled by this region.

AIMS ratings--repeatability

In the present study, two raters, a psychologist and a nurse, each made five independent ratings of 30 different video-recorded patient-examinations. Having thus excluded patient fluctuation, individual-rater consistency and between-rater agreement over the 6 weeks of the study are examined. While between-rater agreement was apparently being maintained, mean AIMS scores steadily increased. In the hands of these raters, AIMS items 2 and 4 emerged as very reliable, while items 1, 6, and 7 showed high variability. Some patients appeared to be hard to rate. Differences between the study raters and the author JB highlight the issue: how reproducible is an AIMS rating?