The use of an oral fluid immunoglobulin G ELISA for the detection of Helicobacter pylori infection in children

BACKGROUND

Enzyme linked immunosorbent assay (ELISA) evaluation of oral fluid immunoglobulin G (IgG) antibodies to Helicobacter pylori is a unique approach for both epidemiological studies and the diagnosis of infection, especially in children. The use of oral fluid sampling to evaluate specific H. pylori IgG antibodies has advantages over serum, including reduced biohazard risk and noninvasive collection. Oral fluid sampling is fast and involves minimal patient discomfort. Since children facilitate transmission of H. pylori infection, a simple, accurate, noninvasive diagnostic test is necessary for large epidemiologic studies. The aim of our study was to evaluate a new oral fluid ELISA for detection of IgG antibodies to H. pylori in children.

MATERIALS AND METHODS

We compared this new oral fluid ELISA with the HM-CAPTM serum ELISA and gastric biopsy histology using 779 oral fluid samples from children collected at 11 clinical sites across the United States. This cohort included 315 children symptomatic for abdominal pain and 464 asymptomatic. All samples were evaluated in a double blind manner. The oral fluid ELISA demonstrated a sensitivity of 76.2% and a specificity of 94.0% in children 2 months old to 201/2 years, as compared with the HM-CAPTM serologic assay. The assay's sensitivity improved to 81.3% in children aged 5 or greater and the specificity remained at 94.0%. When compared with gastric biopsy histology in the same age group, the oral fluid ELISA demonstrated a sensitivity of 71.7% and a specificity of 90.4%.

RESULTS

This new oral fluid ELISA is moderately sensitive and offers a very specific method for detecting H. pylori infection in older children, but it is of little value in children under the age of 5 years.

CONCLUSIONS

Overall, we conclude that this oral fluid ELISA does not appear to be a helpful clinical tool for the diagnosis of H. pylori infection in children.

Diagnosis and treatment of feeding disorders in children with developmental disabilities

OBJECTIVES

To determine the results of diagnostic evaluation and the effects of nutritional intervention on energy consumption, weight gain, growth, and clinical status of children with neurodevelopmental disabilities and suspected feeding disorders.

METHODS

We studied 79 children with moderate to severe motor or cognitive dysfunction (male:female, 38:41; age, 5.8 +/- 3.7 years) who were referred for diagnosis and treatment of feeding or nutritional problems. Initial assessments included a 3-day calorie intake record, videofluoroscopic swallowing study (VFSS), 24-hour intraesophageal pH monitoring, milk scintigraphy, and esophagogastroduodenoscopy.

RESULTS

These studies demonstrated gastroesophageal reflux (GER) with or without aspiration in 44 of 79 patients (56%), oropharyngeal dysphagia in 21 (27%), and aversive feeding behaviors in 14 (18%). Diagnosis-specific approaches included medical GER therapy in 20 patients (25%), fundoplication plus gastrostomy tube (GT) in 18 (23%), oral supplements in 17 (22%), feeding therapy only in 14 (18%), and GT only in 10 (13%). After 24.6 +/- 3.0 months, relative calorie intake, expressed as intake (kcal/d)/recommended daily allowance (RDA, kcal/d), improved significantly (initial:final = 0.78 +/- 0.36:1.23 +/- 0.27). The z scores increased significantly for both weight (initial:final = -2.80 +/- 1.33:-0.81 +/- 0.69) and height (-3.14 +/- 0.98:-2.00 +/- 0.67). Improved subcutaneous tissue stores were demonstrated by increased thickness of both subscapular skinfolds (change = 71% +/- 26%) and triceps skinfolds (38% +/- 17%). After nutritional intervention, the acute care hospitalization rate, compared with the 2-year period before intervention, decreased from 0.4 +/- 0.18 to 0.15 +/- 0.06 admissions per patient-year and included only 3 admissions (0.02 per patient-year) related to feeding problems.

CONCLUSIONS

In children with developmental disabilities, diagnosis-specific treatment of feeding disorders results in significantly improved energy consumption and nutritional status. These data also indicate that decreased morbidity (reflected by a lower acute care hospitalization rate) may be related, at least in part, to successful management of feeding problems. Our results emphasize the importance of a structured approach to these problems, and we propose a diagnostic and treatment algorithm for children with developmental disabilities and suspected feeding disorders.children, developmental disabilities, fundoplication, gastroesophageal reflux, gastrostomy, hospitalization, nutrition.

Flexor tendon repair using a stainless steel external splint. Biomechanical study on human cadaver flexor tendons

A stainless steel external tendon splint was used in repair of cadaver tendons and compared with standard tendon repairs with suture. The splint was combined with a Kessler repair and tested against the Kessler, Becker, and Savage repairs in fresh human cadaver flexor digitorum profundus tendons. Biomechanical testing was done on a tensile testing machine, and load-displacement curves were generated. The repairs using the external tendon splint demonstrated a range of improvement of 32 to 146% in mean maximal tensile strength and a 20 to 185% improvement of mean ultimate tensile strength compared with all other repairs. The external tendon splint is relatively easy to apply to a tendon. The repair is strengthened and becomes capable of withstanding early active range of motion exercises. In vivo testing will be needed to assess the potential clinical usefulness of such a device.

Flexor tendon repair using a stainless steel internal anchor. Biomechanical study on human cadaver tendons

We have developed a stainless steel internal tendon anchor that is used to strengthen a tendon repair. This study tested its use in vitro to produce a repair that can withstand the tensile strength demands of early active flexion. Fresh human cadaver flexor digitorum profundus tendons were harvested, divided, and then repaired using four different techniques: Kessler, Becker or Savage stitches, or the internal tendon anchor. The internal splint repairs demonstrated a 99-270% increase in mean maximal linear tensile strength and a 49-240% increase in mean ultimate tensile strength over the other repairs. It is hoped that this newly developed internal anchor will provide a repair that will be strong enough to allow immediate active range of motion.

Hostility and hearing protection behavior: the mediating role of personal beliefs and low frustration tolerance

The authors examined whether hostility would negatively be associated with occupational health behavior, namely, the use of hearing protection devices (HPDs). Also examined as possible mediators were the protection motivation theory (PMT) components and low frustration tolerance (LFT). Participants were 226 male industrial workers, all exposed to potentially hearing-damaging noise. Hostility was negatively related to HPD use. It moderately correlated with the PMT components: negatively with perceived susceptibility, severity, effectiveness, and self-efficacy and positively with perceived barriers. Hostility correlated highly with LFT. Regression analyses confirmed the mediating role of perceived barriers, low self-efficacy, and LFT in the negative relationship between hostility and the use of HPDs. Thus, intrapsychic characteristics of hostile people may be significant for hearing protection behavior.

Hostility and hearing protection behavior: the mediating role of personal beliefs and low frustration tolerance

The authors examined whether hostility would negatively be associated with occupational health behavior, namely, the use of hearing protection devices (HPDs). Also examined as possible mediators were the protection motivation theory (PMT) components and low frustration tolerance (LFT). Participants were 226 male industrial workers, all exposed to potentially hearing-damaging noise. Hostility was negatively related to HPD use. It moderately correlated with the PMT components: negatively with perceived susceptibility, severity, effectiveness, and self-efficacy and positively with perceived barriers. Hostility correlated highly with LFT. Regression analyses confirmed the mediating role of perceived barriers, low self-efficacy, and LFT in the negative relationship between hostility and the use of HPDs. Thus, intrapsychic characteristics of hostile people may be significant for hearing protection behavior.

Usefulness of the protection motivation theory in explaining hearing protection device use among male industrial workers

The present study examined the usefulness of personal variables: noise annoyance, and components of the protection motivation theory (R. W. Rogers, 1983) along with social-organizational factors in explaining hearing protection device (HPD) use among Israeli manufacturing workers. Participants were 281 men exposed to harmful noise levels for which routine HPD use is required by regulation. In practice, 3 HPD user groups were identified: nonusers (n = 38), occasional users (n = 125), and regular users (n = 118). HPD use was objectively verified. HPD use was primarily related to the personal variables but not to management pressure, coworker pressure, or family support. The most powerful predictors of HPD use were perceived self-efficacy (for long-term HPD use), perceived susceptibility (to hearing loss), and noise annoyance, together explaining 48% of the outcome variance. These findings have implications for interventions aimed at motivating workers to use HPDs regularly.

Endoscopic-assisted midface lift utilizing retrograde dissection

Endoscopic facial surgery is gaining wide acceptance, as results are providing comparable if not superior to the standard, superficial musculoaponeurotic system rhytidectomy, with minimal scarring. Frontal branch facial nerve injury remains a troublesome complication. The purpose of our study was to determine if a subciliary retrograde dissection would decrease facial nerve injury and allow for more accurate midfacial suspension. Fresh cadaver dissections were performed using endoscopic equipment. Anterograde temporal incisions in the scalp and retrograde subciliary incisions were studied. The anterograde temporal dissection was developed deep to the superficial layer of the deep temporal fascia. Retrograde subciliary dissection was subperiosteal. Forty-nine endoscopic-assisted midface lifts were performed. Midfacial suspension was accomplished with nonabsorbable sutures placed in the suborbicularis oculi fascia, anchored to the deep temporal fascia. Two of three endoscopic-assisted procedures done in the anterograde fashion, without a subciliary incision, experienced transient frontal branch injury, which resolved within 6 weeks. The remaining forty-six patients, operated with a combined subciliary and temporal approach, experienced no frontal branch injuries. We have found that the retrograde dissection through a subciliary incision substantially reduced the incidence of facial nerve injury, provided direct visualization of the suborbicularis oculi fascial layer (allowing more accurate midfacial suspension), and reduced total operative time.

Usefulness of the protection motivation theory in explaining hearing protection device use among male industrial workers

The present study examined the usefulness of personal variables: noise annoyance, and components of the protection motivation theory (R. W. Rogers, 1983) along with social-organizational factors in explaining hearing protection device (HPD) use among Israeli manufacturing workers. Participants were 281 men exposed to harmful noise levels for which routine HPD use is required by regulation. In practice, 3 HPD user groups were identified: nonusers (n = 38), occasional users (n = 125), and regular users (n = 118). HPD use was objectively verified. HPD use was primarily related to the personal variables but not to management pressure, coworker pressure, or family support. The most powerful predictors of HPD use were perceived self-efficacy (for long-term HPD use), perceived susceptibility (to hearing loss), and noise annoyance, together explaining 48% of the outcome variance. These findings have implications for interventions aimed at motivating workers to use HPDs regularly.

Intestinal perforation 14 years after abdominal irradiation and chemotherapy for Wilms tumor

A 3-year-old girl underwent left nephrectomy and removal of a tumor thrombus from the inferior vena cava and right atrium in 1978 because of Wilms tumor. Her treatment consisted of tumor bed irradiation (4,000 cGy) and chemotherapy with actinomycin D, vincristine, and doxorubicin. The patient underwent laparotomy 2 months after completion of abdominal irradiation to relieve intestinal obstruction. Fourteen years later, she underwent another laparotomy because of an "acute abdomen" and was found to have perforation of the jejunum in the radiation field. Histopathological examination of resected intestine revealed evidence of severe chronic radiation enteritis, A diagnosis of chronic radiation enteritis should be considered in patients who had received abdominal irradiation and who manifest abdominal pain/vomiting even several years after irradiation.

Treating alcoholism through a narrative approach. Case study and rationale

A case study illustrates the narrative or story-telling approach to treating alcoholism. We discuss the rationale for this method and describe how it could be useful in family practice for treating people with alcohol problems.

Preventing burnout: increasing professional self efficacy in primary care nurses in a Balint Group

Nursing is reported to be a stressful occupation, and chronic stress is often associated with burnout. Many ways of reducing stress have been proposed. Of these, the Balint group method provides a forum in which health professionals can present and attempt to resolve stressful situations with clients, coworkers, or other professionals. Balint groups help health professionals improve coping with psychosocial stressors in a supporting and accepting group atmosphere. This article reports changes in professional self efficacy associated with reduced burnout in a group of 13 nurses working in community based primary care clinics. Results showed significant increases in awareness and ability cognitions after the Balint group and reduced emotional exhaustion and cognitive weariness. The ramifications of these findings are discussed.

Health responsibility and workplace health promotion among women: early detection of cancer

The importance of health responsibility as one aspect of a health-promoting lifestyle has been emphasized repeatedly. Yet there are only a few empirical studies of its role in preventive behavior. We examined the relationship between health responsibility and early-detection practices for breast and cervical cancer. A group of 253 women employees of a large industrial company participated in a cancer screening program subsidized by the employer. They completed questionnaires assessing health responsibility and reported early-detection practices: frequency of breast self-examination and physician breast examinations, frequency of Pap tests, and time lapsed since last Pap test and breast examinations. Health responsibility was a significant independent predictor of breast examination indicators but not of Pap tests. Education level was an important predictor for Pap tests, and age predicted most early-detection practices. The findings lend some support to the role of health responsibility in initiating breast examinations. Better prediction of early-detection practices could be achieved by adding cognitive and emotional components to the existing responsibility scale and by distinguishing between retrospective and prospective responsibility.

Correction of congenital indirect hyperbilirubinemia by small intestinal transplantation

INTRODUCTION

Crigler-Najjar syndrome, type I, is a disease characterized by complete absence of hepatic bilirubin glucuronidation. The congenital indirect hyperbilirubinemia is due to an autosomal recessive deficiency of the enzyme, uridine diphosphate glucuronosyl transferase (UDPGT). The inbred homozygous Gunn rat is also deficient in UDPGT, exhibits unconjugated hyperbilirubinemia, and is an excellent animal model of the Crigler-Najjar syndrome. This study was performed to test the ability of transplanted intestine from normal Wistar rat donors to correct the deficiency in hepatic bilirubin conjugation.

MATERIALS AND METHODS

In phase 1, Gunn rats underwent 40-cm heterotopic small-bowel transplants from either Wistar (experimental) or Gunn (control) rats. In phase 2, 15- to 20-cm Wistar-to-Gunn jejunal transplants were placed either heterotopically or orthotopically (in intestinal continuity). All rats were treated with cyclosporin A (CsA), 5 mg/kg per day. Serum bilirubin levels were determined spectrophotometrically at weekly intervals posttransplantation. In phase 2, UDPGT activity was quantitated at 0, 2, 4, and 8 weeks using known quantities of bilirubin as substrate.

RESULTS

Total bilirubin levels decreased significantly in the 40-cm heterotopic transplant recipient rats. From the initial values of 7.12 +/- 0.59 mg/dL, levels reached the nadir of 4.23 +/- 0.27 mg/dL. A parallel drop in serum levels of indirect bilirubin was noted (5.04 +/- 0.54 mg/dL to 2.74 +/- 0.23 mg/dL). After 6 weeks, bilirubin levels began to rise toward pretransplant values. In contrast, there was no significant change in bilirubin levels in the control Gunn-to-Gunn rats. Fifteen- to 20-cm heterotopic Wistar-to-Gunn transplants caused a qualitatively similar drop in total and indirect bilirubin levels. Orthotopic (in continuity) Wistar-to-Gunn transplants lowered serum bilirubin levels more rapidly, and the effect was sustained throughout the 8-week study period. By 1 week posttransplantation, total bilirubin levels dropped from 5.11 +/- 0.48 mg/dL to 2.41 +/- 0.16 mg/dL (P < 0.05); data at 8 weeks averaged 1.84 +/- 0.35 mg/dL. Respective data for indirect bilirubin levels were 4.81 +/- 0.45 mg/dL, 2.26 +/- 0.18 mg/dL, and 1.35 +/- 0.39 mg/dL. Wistar rat UDPGT activity in intestine and liver averaged 0.61 +/- 0.05 and 1.88 +/- 0.06 mg bilirubin conjugated/mg tissue per hour, respectively. Enzyme activity in the transplanted intestine persisted throughout the course of the study.

CONCLUSION

Transplants of small intestine with known UDPGT activity partially corrected the deficiency in Gunn rats and allayed the hyperbilirubinemia. Since the small intestine is known to contain small but significant amounts of a large number of predominantly hepatic enzymes, bowel transplantation may be an appropriate treatment for this and other similar genetic enzyme deficiencies.

Listening to patients' stories. Storytelling approach in family medicine

This paper discusses the relevance of a storytelling approach for understanding psychological problems in family practice and assesses the value of such an approach.

Noise exposure, noise annoyance, use of hearing protection devices and distress among blue-collar workers

OBJECTIVES

This study tested the hypotheses that, in high noise levels [> or = 85 dB(A)], hearing protection devices are used largely by workers sensitive to noise, as reflected by reports of noise annoyance, and that the usage would reduce distress symptoms.

METHODS

Data collected from 1587 healthy male blue-collar workers included noise exposure level, noise annoyance, use of hearing protection devices, distress symptoms (somatic complaints and poststress irritability), and possible confounding by age, education and ethnic origin.

RESULTS

Multiple logistic regression results indicated that the use of hearing protection devices was related to noise exposure level [odds ratio (OR) 2.94, 95% confidence interval (95% CI) 2.58--3.30], but more so to high noise annoyance (OR 3.03, 95% CI 2.77--3.29), even after control for age, education, and ethnic origin. No interaction was found between noise level and noise annoyance. These findings highlight the contribution of noise annoyance to the use of hearing protection devices. Of the 42.6% of workers using hearing protection devices in the presence of high ambient noise, 60% were highly annoyed. Noise-annoyed workers also tended to wear hearing protection devices even in low noise levels. The use of hearing protection devices was associated with lower distress symptoms among the low and moderately annoyed workers, but among the highly annoyed workers the reverse was true.

CONCLUSIONS

Thus, for the highly annoyed workers, the use of hearing protection devices was perhaps an additional source of stress. One immediate implication of this study is that future intervention procedures should focus on unannoyed workers who tend to use hearing protection devices less.

Teaching interpersonal skills to occupational and environmental health professionals

An innovative course for teaching communication and interpersonal relationships was delivered to 29 environmental and occupational health professionals. This course aimed to highlight interpersonal and emotional aspects in the professional-client interaction and incumbent communication aspects when consulting team members, colleagues, and nonprofessionals in the occupational arena. Various experiential and other teaching techniques were used. Assessment showed that participants reported the positive features of such a course although few changes in either psychosocial abilities or awareness were evident. Possible ramifications of the findings are discussed.

Treatment of post-traumatic stress disorders: an applied rear-echelon approach

This paper presents an applied innovative rear-echelon approach for the treatment of recalcitrant soldiers suffering from post-traumatic stress disorder in the 1982 Lebanon-Israel War. This was used as an alternative to psychiatric hospitalization. Use was made of a short-term, goal-directed, multidisciplinary treatment approach within the confines of a clear military setting. Reintegration into military and civilian life was an integral part of the program. Results indicated that at discharge, all soldiers showed a markedly improved clinical picture. Follow-up results 2.5 years later indicated that the percentage of regulars who returned to combat units doubled, whereas the reservists showed a slight tendency toward deterioration. Follow-up 6 years later showed the continuation of the same tendency. Ramifications of our findings are extensively discussed.

Israel defence forces experiences with treatment of POWs and families: an innovative multifaceted treatment model

This paper attempts to provide an integrative, multifaceted treatment approach for the surviving POW and his family. The model takes into account the individual, family, interpersonal, and community effects of captivity from the time of captivity until 1 year later. Ramifications of this model are discussed.

Personal determinants of leisure-time exercise activities

This study investigated the importance of personal determinants such as self-efficacy, beliefs about the contribution of exercise, health locus of control, and dispositional optimism for leisure-time exercise in a working population. The main predictors of such exercise were beliefs and self-efficacy with the generalization of the latter to eat correctly. Beliefs and efficacy expectations were highly correlated. Neither health locus of control nor dispositional optimism was related to leisure-time exercise; however, optimism was related to the positive belief that exercise contributes to health. Ramifications of the findings were carefully described.

The belief in the transmigration of souls: psychotherapy of a Druze patient with severe anxiety reaction

In this paper the culture-sensitive psychotherapy of a 19-year-old Druze patient with severe anxiety reaction is described. The patient explained his anxiety and his symptoms as stemming from violent death in his former life and subsequent transmigration. The therapists joined the patient's explanatory model and previous traditional healing, adding hypnotic suggestion which relieved the symptoms. The relationship of patient symptomatology to cultural background, multiple personality disorder, possession and dissociation is discussed. The strategic combination of culture-specific and modern psychiatric approaches is advocated in similar cases.

The belief in the transmigration of souls: psychotherapy of a Druze patient with severe anxiety reaction

In this paper the culture-sensitive psychotherapy of a 19-year-old Druze patient with severe anxiety reaction is described. The patient explained his anxiety and his symptoms as stemming from violent death in his former life and subsequent transmigration. The therapists joined the patient's explanatory model and previous traditional healing, adding hypnotic suggestion which relieved the symptoms. The relationship of patient symptomatology to cultural background, multiple personality disorder, possession and dissociation is discussed. The strategic combination of culture-specific and modern psychiatric approaches is advocated in similar cases.

Immunocytochemical characterization of the endocytic and phagolysosomal compartments in peritoneal macrophages

We have used endocytic and phagocytic tracers in an EM immunocytochemical study to define the compartments of the phagocytic and endocytic pathways in mouse peritoneal macrophages. Endocytosed BSA-gold appeared successively in early endosomes, spherical endosomal vesicles, a late endosomal tubuloreticular compartment (TC), and terminal lysosomes. The TC appeared as an elaborate structure enriched for the lysosomal membrane glycoproteins Lamp 1 and Lamp 2, and expressing significant levels of rab7, a late endosome-specific GTP-binding protein. The cation-independent mannose-6-phosphate receptor was restricted to specialized regions of the TC that were predominantly adjacent to the Golgi complex. Both the early endosome and the TC had coated bud structures whose composition and function are presently unknown. Phagolysosomes containing latex beads expressed the same membrane antigens and received endocytic tracers simultaneously with the TC. Since the membrane surrounding both organelles was also in direct continuity, we assume that both structures form one functional compartment. Macrosialin, an antigen confined to macrophages and dendritic cells, was heavily expressed in TC and phagolysosomal membranes with low levels being detected in other endosomal compartments and on the cell surface. Treatment of cells with wheat germ agglutinin drastically altered the morphology of the TC, giving rise to sheets of tightly adherent membrane and greatly expanded vesicles, in which cell-associated wheat germ agglutinin was concentrated. The spherical endosomal carrier vesicles loaded with internalized gold tracers clustered nearby, often making contact without fusing. Since the delivery of endocytic tracer to the TC was significantly delayed these experiments suggest that the lectin is somehow preventing the endosome vesicles from fusing with the TC. Collectively, our data argue first that the PLC is equivalent to the "tubular lysosomes" commonly described in macrophages, and second that the meeting of the phagocytic and endocytic pathway occurs in this compartment.

Physicians' detection of psychological distress in primary-care clinics

This study investigated the amount of psychological distress reported by 182 soldiers in the Israeli military and compared soldiers' self-ratings of distress with ratings by military physicians of observed distress. Comparisons indicated a low detection rate by physicians with only 13% of self-reported cases of emotional distress identified. This and several related findings were taken to indicate shortcomings in medical care. Possible remedies include additional psychiatric training for military physicians, less frequent rotation of physicians to allow for more stable care, and the initiation of mental health education among soldiers.

True conversive hallucinations

A case of true conversive hallucinations in a 19-year-old female soldier is described. This phenomenon is rare and should be distinguished from psychotic or dissociative states.

Malingering in the clinical setting: practical suggestions for intervention

The complex nature of malingering observed in the military is examined, and a practical approach to the handling of such behaviour in the clinical setting is outlined. The complementary tasks of the mental health professional, the primary care physician, and other community agents are discussed.

Debate reawakened: premorbid factors for soldiers with refractory posttraumatic stress disorder

Soldiers with severe Posttraumatic Stress Disorder who did not respond favourably to the front echelon treatment units, were treated in a rear echelon treatment centre, named Combat Fitness Retraining Unit, an alternative to psychiatric hospitalization. The soldiers were given individual clinical interviews; their combat potential scores were measured to tap premorbid factors which may have contributed to the development of symptoms. Analysis indicated that (1) in the clinical interview subjects showed clear interpersonal, school, family, and army adjustment problems prior to the trauma, (2) soldiers with Posttraumatic Stress Disorder treated in the rear unit tended to come from the lower end of the military combat potential level. Ramifications of these findings were carefully elucidated.

Detection of herpes viral genomes in normal and diseased corneal epithelium

Herpetic ocular disease is one of the major causes of corneal blindness. Clinical diagnosis of corneal disease is based principally on corneal appearance. However, abnormal morphology of the corneal epithelium (CE) is not an indicator for the presence of a herpes virus. Further, it has not been established if herpes viruses are present in normal corneal epithelial tissue. In these studies, the polymerase chain reaction was used to evaluate normal and diseased corneal epithelium for the presence of herpes simplex virus type 1 (HSV-1), Epstein-Barr virus (EBV) and cytomegalovirus (CMV) genomic sequences. Thirty-two normal corneal epithelium specimens obtained from cadavers shortly after death were analyzed for HSV-1, EBV and CMV genomic sequences. Three of the 32 normal CE specimens were positive for amplified EBV DNA, 1 was positive for HSV-1 DNA, and none was positive for CMV DNA. We also tested eight herpetic dendritic lesions of which 3 were HSV-1 culture and PCR positive. The remaining five dendritic lesions were HSV-1 culture and PCR negative. Since these lesions were not evaluated for other herpesviruses, the etiology of these dendritic lesions is unknown. Six corneal epithelium samples from HIV-infected donors were negative for EBV, CMV and HSV-1 amplified sequences. Positive EBV, CMV and HSV-1 serology on all normal donors and on donors with clinically apparent disease did not correlate with positive PCR results. The results of these studies suggest that EBV and HSV-1 DNA can be amplified from a small percentage of apparently normal corneal epithelium.

The doctor and his feelings: a course for residents in family medicine

A course on the doctor and his feelings was presented as part of a programme for family medicine residents. The course was led by family physicians and behavioural science professionals who taught as an integrated team. Various teaching techniques were utilized to highlight emotional aspects of the doctor-patient relationship to inexperienced residents. Pre- and post-course assessments suggested there were benefits in a short intensive course of this nature. Possible explanations for the findings are discussed.

Differential expression of membrane sialoglycoproteins in exudate and resident mouse peritoneal macrophages

Wheat germ agglutinin (WGA) has been used to define biochemical differences between exudate and resident macrophages in the peritoneal cavity of mice. Western blotting with 125I-WGA identifies a restricted set of glycoproteins in elicited peritoneal macrophages (M phi) (recruited with thioglycollate or periodate) and fully activated M phi (recruited with live Bacille Calmette-Guerin, or heat-killed Corynebacterium parvum); the major species migrates with Mr 89–115 kDa in 10% acrylamide gels. These glycoproteins are not detected in resident peritoneal M phi, nor in thymocytes, neutrophils, lymphocytes and a variety of non-M phi cell lines. The binding of WGA is sensitive to neuraminidase, which exposes binding sites on these proteins for peanut agglutinin and reduces their electrophoretic mobility; these features are typical of O-linked sialo-oligosaccharides. In culture, exudate M phi increase their WGA-binding content over 48 h, and continue to display a phenotype distinct from that of resident peritoneal M phi. The stable differential expression of these sialoglycoproteins, by elicited and activated versus resident peritoneal M phi, suggests that biochemical modification during the synthesis and expression of membrane glycoproteins accompanies M phi recruitment to an inflammatory focus.

Plasma membrane receptors of the mononuclear phagocyte system

Plasma membrane receptors control macrophage activities such as growth, differentiation and activation, migration, recognition, endocytosis and secretion. They are therefore important in a wide range of physiological and pathological processes including host defence, inflammation and repair, involving all systems of the body including the arterial wall and nervous system. The versatile responsiveness of these cells to various stimuli depends on their ability to express a large repertoire of receptors, some restricted to macrophages and closely related cells, others common to many cell types. This volume contains reviews of the macrophage receptors that are best characterized and deals with aspects of signal transduction and function of the actin cytoskeleton. Our introduction is designed to place these topics in perspective. We summarize features of constitutive and induced mononuclear phagocyte distribution within the body and consider receptor expression and macrophage responses in the context of cell heterogeneity associated with its complex life history. We classify receptors discussed in detail in other chapters, list ligand-binding properties that are not as well defined, and briefly review general features of receptor function in macrophages. An understanding of macrophage receptor biology should bring insights into the contribution of these cells to physiology and disease and result in an improved ability to manipulate activities within the mononuclear phagocyte system.

Tissue-specific gene expression results from a purine- and pyrimidine-free diet and 6-mercaptopurine in the rat small intestine and colon

Dietary purines and pyrimidines are not considered to have a nutritional role, much less a direct effect on the functioning of the gastrointestinal tract. We found that a dramatic decrease in adult rat small intestinal and colonic total ribonucleic acid (RNA) results from the removal of dietary purines and pyrimidines or the administration of 6-mercaptopurine. Ribonucleic acid hybridization analysis indicated specific decrease of the messenger ribonucleic acid (mRNA) for the purine salvage enzymes hypoxanthine-guanine phosphoribosyl transferase and adenine phosphoribosyl transferase in the small intestine and proximal colon but not in the liver of animals fed a diet lacking purines and pyrimidines. Levels of intestinal and hepatic beta-actin mRNA transcripts were generally not depressed by either diet or by the administration of 6-mercaptopurine. Liver hypoxanthine-guanine phosphoribosyl transferase and adenine phosphoribosyl transferase mRNAs were unaffected by the change in diet but were lowered by the administration of 6-mercaptopurine. These data indicate that nutrition and 6-mercaptopurine affect both total RNA, and individual mRNA concentrations at specific sites in the gastrointestinal tract. These findings are of potentially great significance because the regulation of intestinal total RNA levels and purine salvage mRNAs by both 6-mercaptopurine and a purine- and pyrimidine-free diet suggests a potential mechanism by which dietary components differentially control specific proteins synthesized in the body. These findings may be related to the efficacy of 6-mercaptopurine as well as so-called elemental diets as therapeutic agents in chronic inflammatory bowel disease (i.e., Crohn's disease).

Fibrinogen synthesis in the rat; role of the C terminal end of the gamma chain of fragment D1

The terminal fibrinogen degradation product fragment D1 is known to regulate fibrinogen synthesis but the determinants in the D1 molecule responsible for this property are not known. The effect of fragment D1 on fibrinogen synthesis by the isolated perfused rat liver was studied using the (14C) carbonate method. Addition of 25 mg of fragment D1 to 100 ml of whole blood perfusate resulted in a significant increase in fibrinogen synthesis. When the C-terminal end of the gamma-chain of D1 was further plasmin-degraded to form fragment D3 this fibrinogen-enhancing effect was lost. Our studies suggest that the C-terminal of the gamma-chain of fragment D1 plays a role in regulating fibrinogen synthesis by the isolated rat liver.

Psychosocial and medical factors influencing referral to an Israeli Air Force Base Mental Health Clinic

This preliminary study concerned examining a number of psychosocial and medical factors involved in the referral of 207 conscripted soldiers to an Israel Air Force Base Mental Health Clinic. These factors were age, sex, education, source of referral, and timing of referral during service. The nature of medical complaints before and after psychological intervention was also examined. Results suggest an effective medical psychological cooperation can significantly reduce minor psychological problems in a population of drafted soldiers.

Fear of flying: an Israeli Air Force short case report

This paper outlines the brief psychological treatment of an Israel Air Force pilot presenting with the fear of flying disorder. An in-depth case report is described and a variety of issues are discussed, including presentation of symptoms and psychotherapeutic techniques utilized, as well as the complicated role of the Mental Health Officer treating the problem within the military system.

Anxiety and hirsutism

To compare anxiety of 15 hirsute women and of 20 control subjects (student nurses) seen at the Soroka Medical Center, Israel, three hypotheses were considered: patients with hirsutism have significantly higher state anxiety than the control sample; patients with hirsutism show significantly higher trait anxiety than the control sample; the extent of hirsutism generates no significant differences in state or trait anxiety. The two groups were compared on the Hebrew version of the State-Trait Anxiety Inventory. The first two hypotheses were confirmed but no correlation was found between extent of hirsutism and state or trait anxiety. The findings are discussed and implications made with regard to physicians' understanding of the hirsute patient.

A simplified plaque assay for influenza viruses in Madin-Darby kidney (MDCK) cells

A variety of influenza A and B viruses plaque in MDCK cell in trypsin is added only at the time of viral adsorption to the monolayer. Therefore, a conventional soft-agar overlay can be employed without addition of proteolytic enzymes. Plaquing efficiency was comparable to that when embryonated eggs were used to determine infectivity. Finally the method is simple and economical.