Delayed antivenom treatment for a patient after envenomation by Crotalus atrox

Bites by the Western diamondback rattlesnake (Crotalus atrox) are the most common cause of envenomation in Texas. We describe a patient who had delayed administration of antivenom after envenomation by C atrox. Because of an initial adverse response to a test dose, the patient had been unwilling to receive antivenom therapy. When compartment syndrome developed 52 hours after envenomation, however, the patient consented to antivenom therapy as an alternative to fasciotomy. We documented a decrease in compartment pressures and resolution of thrombocytopenia that was concomitant with antivenom administration.

Complementary health practitioners' attitudes, practices and knowledge related to women's cancers

OBJECTIVE

To document the attitudes, practices and knowledge of 3 groups of complementary practitioners (naturopathic doctors, chiropractors and massage therapists) regarding women's cancers in general and ovarian cancer specifically.

DESIGN

A mailed survey questionnaire was followed by a reminder card and a second mailing of the questionnaire.

SETTINGS

National samples were obtained for naturopathic doctors and chiropractors. The massage therapist sample was drawn from Ontario only because of the absence of a national listing of massage therapists.

MAIN OUTCOME MEASURES

Practitioners reported response to patients' suspicious symptoms. Practitioners' perceptions of patients' motivations for seeking treatment. Practitioners' satisfaction with interactions with conventional practitioners. Practitioners' perceptions of their role in the care of women at risk of, or diagnosed with, cancer. Practitioners' perceptions of their knowledge regarding women's cancers. Practitioners' knowledge specific to ovarian cancer.

RESULTS

A total of 894 completed questionnaires were returned, providing a response rate of 56%. The vast majority of practitioners who saw women with symptoms possibly related to cancer referred them to a family physician or a cancer specialist. Motivations that practitioners most frequently heard expressed by women seeking complementary treatments were "maximizing quality of life," "seeking natural approaches to healing" and "looking to stay well when disease is in remission." Most respondents were dissatisfied with patient-related communication with both family physicians and cancer specialists. The majority of complementary practitioners indicated that they have an important role to play in the postdiagnostic care of women with cancer. Considerable interest was expressed in further education concerning ovarian cancer.

CONCLUSIONS

Whereas the professions reached through this survey differ in important ways from each other, they share an interest in being involved in the care of women with cancer, as well as an enthusiasm for the development of continuing professional education programs to help them better serve their clients.

Cardiovascular primordium of the rat embryo following in utero exposure to alcohol and caffeine

The influence of alcohol and caffeine on cardiac embryogenesis was investigated in the rat. No disturbances were detected in the yolk sac circulatory system and allantois of embryos exposed to ethanol, but in several cases the cardiac tube was delayed in its development. Caffeine had no gross morphological effect on the developing cardiovascular system. However, cardiac morphogenesis was significantly impaired in embryos recovered from mothers treated with both ethanol and caffeine.

Mobilizing schools for suicide prevention

Experience in providing consultation and survivor counseling to school personnel following student suicides led to the development of a program of prevention through training school personnel. The goal of the program was to increase the ability of resource persons available to adolescents--teachers, counselors and school nurses--to recognize signs of suicidal depression and to respond effectively to suicidal students. This report describes that program, the reaction of the participants and the observations of the project staff, and comments on the feasibility of this approach as a means of helping to prevent suicide among adolescents.

Cyclic adenosine 3':5'-monophosphate phosphodiesterase. Distinct forms in human lymphocytes and monocytes

Adenosine 3':5'-monophosphate (cyclic AMP) phosphodiesterase activity of normal human peripheral blood leukocyte suspensions containing 90% lymphocytes and 10% monocytes showed anomalous kinetic behavior indicative of multiple enzyme forms. Kinetic analyses of purified lymphocyte (99%) or monocyte preparations (95%) indicated that only one type of phosphodiesterase was present in each cell type. None of the preparations contained any detectable guanosine 3':5'-monophosphate (cyclic GMP) hydrolytic activity. The lymphocyte enzyme had an apparent Km congruent to 0.4 muM for cyclic AMP and Vmax congruent to 0.5 picomoles/min/10(6) cells. These kinetic parameters were confirmed by several cell purification techniques used alone and sequentially. Sedimentation velocity analyses indicated that the higher Km monocyte enzyme had a molecular weight near 45,000 and that the lower Km lymphocyte enzyme most likely had a molecular weight near 98,000. A variety of procedures led to a loss of the higher molecular weight, high affinity enzyme leaving only the enzyme of 45,000 daltons with a much lower substrate affinity. A long term, stable human lymphoblastoid cell line had cyclic AMP phosphodiesterase activity that was similar to the lymphocyte enzyme by both physical and kinetic criteria. Lymphocyte cyclic AMP phosphodiesterase appears to be a soluble enzyme whose pH and temperature optima and cationic requirements are similar to those of other mammalian phosphodiesterases. The distinct cyclic AMP phosphodiesterase forms of these cells may possibly represent the basic, active subunit of mammalian cyclic nucleotide phosphodiesterases. We hypothesize that the extremely high affinity cyclic AMP phosphodiesterase of normal lymphocytes plays an important role in the regulation of normal function in these cells, and also in the rapid proliferative responses characteristic of the stimulated lymphocyte.