The management of terminally ill patients. Ethics of Clinical Practice Subcommittee, Ethics Review Committee, Central Sydney Health Service.
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Biomedical subjects
Publications and source records attributed to M A Harris.
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A recent study reported elevated levels of 1,2,8,9-tetrachlorodibenzo-p-dioxin (1,2,8,9-TCDD) in crustaceans and finfish collected from Newark Bay, New Jersey (Rappe et al., 1989). The authors suggested that the presence of this compound in biota was due to operations at a former 2,4,5-trichlorophenoxy acetic acid (2,4,5-T) manufacturing facility located on the lower Passaic River. Since 1,2,8,9-TCDD had been identified in two soil samples claimed to be associated with the site, it was concluded that the former manufacturing plant was the source of this compound. A review of the scientific literature was conducted to evaluate whether this isomer is associated with the formulation of 2,4,5-T and to determine whether 1,2,8,9-TCDD is commonly found in the aquatic environment. Measurements and chromatographic data from known sources of polychlorinated dibenzo-p-dioxins indicate that incinerator fly ash, soot from wood-burning chimneys, and the combustion of polychlorinated biphenyls and some chlorophenoxy herbicides are sources of 1,2,8,9-TCDD. This isomer has never been found in samples of 2,4,5-T. We conclude, therefore, that the presence of 1,2,8,9-TCDD in Newark Bay biota is not associated with 2,4,5-T manufacturers but, rather, the result of various commercial, residential, municipal, and industrial combustion processes.
Associations among sibling relations and the psychosocial and illness-specific adaptation of youths (N = 66) with insulin-dependent diabetes mellitus (IDDM) were examined. The findings suggest that sibling relations, especially sibling conflict, contribute an independent source of variance above and beyond that contributed by demographic characteristics, sibling constellation variables, and important dimensions of family relations in predicting the youths' adaptation. High family-life stress and high sibling status/power contributed unique variance in predicting internalizing behaviors, and male gender and sibling conflict contributed independently to externalizing problems. Sibling conflict also contributed unique variance to the youth's general self-esteem, along with social class and family cohesion, and to their adjustment to IDDM. Data suggest that parent-child dyads and sibling dyads represent interrelated and independent subsystems within the family, and that both subsystems may influence the psychosocial functioning of youths with IDDM.
Ceftriaxone as a single daily intravenous dose for 5 days was used to treat seven patients with proven Haemophilus influenzae epiglottitis. All children responded favourably. The serum levels achieved exceeded the MIC by up to 1500 times at the trough level during and for up to 24 h after the completion of the treatment. Side effects were mild and transient and did not disrupt the continuity of the treatment. Ceftriaxone potentially offers a number of clinical and economic advantages in the management of epiglottitis.
The effect of sucrose consumption on glycemic control in children with insulin-dependent diabetes mellitus is unclear. Eight young subjects, 7-16 years of age, with a duration of diabetes of 2-8 years participated in this study. All subjects consumed four different breakfasts--oatmeal (OM) alone, oatmeal-sucrose (OMS), oatmeal-protein (OMP), and oatmeal with protein and sucrose (OMPS)--on four different days. Addition of sucrose resulted in a slightly greater area under the tolerance curve in 50% of the subjects; however, in 38% of subjects, the area decreased. The peak glucose level was lowest for OM, but there was no statistical difference in the peak levels of the four test meals. The most significant effect on glucose response was a delay in the peak time when protein was added to the meals. Peak times for OM and OMS (mean of 38 min) when fed alone were significantly (p less than 0.05, ANOVA) shorter when compared to the peak time for OMP and OMPS (mean of 54 min). The average recovery time for OMP was longest. Other indices (tolerance index and change of rise in blood glucose) measured were not significantly different among the test meals. This study demonstrates that adding limited sucrose to OM cereal has little effect on the blood glucose response in children with diabetes. Addition of protein and fat clearly delays the glycemic response.
The gene encoding rat seminal vesicle secretion II (SVS II) protein has been cloned from a rat genomic DNA library using a cDNA probe generated from rat dorsal prostate androgen-dependent mRNA. The cloned 7.3-kilobase pair genomic fragment contains approximately 5000 base pairs (bp) of the 5'-flanking region and the entire coding region of the SVS II protein within two exons. A sequence of 4156 bp of the rat SVS II gene has been determined, including 2037 bp of the 5'-flanking region, exon 1 (95 bp), intron 1 (236 bp), exon 2 (1171 bp), and 614 bp of the 3'-flanking region. The 5'-flanking region contains three conserved elements found in other seminal vesicle secretion genes (SVS IV-VI proteins) within 250 bp of the transcription start site as well as a glucocorticoid response element at position -314 in the SVS II gene. The first exon encodes a 22-amino acid leader peptide plus the first 2 amino acids of the secreted protein. The second exon encodes the remaining amino acids in the SVS II protein sequence. The mature protein contains 392 residues and has an Mr of 43,116. Concomitant with the gene analysis, the rat SVS II protein was purified to homogeneity, and 333 residues (85%) of the amino acid sequence were determined by automated Edman degradation. The DNA-deduced sequence and that determined by direct analysis of the protein are in complete agreement. The blocked NH2-terminal amino acid was identified as pyroglutamic acid by mass spectrometry and aminopeptidase digestion. A 13-residue structure with the consensus sequence GSQLKSFGQVKSS is repeated 13 times within the SVS II protein and appears to be involved in the formation of the rat copulatory plug via a transglutaminase reaction cross-linking glutamine and lysine residues. Overall, the SVS II protein sequence exhibits little structural relatedness to any other known protein sequence; however, some similarity can be found between the 13-residue repeat and another repeating structure and apparent transglutaminase substrate in the guinea pig seminal vesicle clotting protein.
Syrian hamster DDT-1 cells are derived from smooth muscle of the ductus deferens. DDT-1 cell growth is increased by the addition of testosterone (T). Acidic fibroblast growth factor (aFGF) or basic fibroblast growth factor (bFGF) also known as heparin binding growth factor I and II (HBGF-I and HBGF-II) can replace T in the stimulation of growth in these cells. This phenomenon is correlated with testosterone's ability to elevate aFGF/HBGF-I mRNA. The increase steady-state levels of aFGF/HBGF-I mRNA were documented by northern blots and by in situ hybridization. Using a 520 bp human aFGF/HBGF-I cDNA probe, a genomic clone with a 38 kb DNA insert was isolated from a cosmid library. By restriction enzyme analysis and southern hybridization, it was determined that there are three coding exons. DNA sequence analysis showed all of the coding region and 3' noncoding sequences were on this clone. A 5' noncoding exon not in the 38 kb insert is indicated, based on the cDNA sequences and genomic sequences of aFGF/HBGF-I's from hamster DDT-1 cells and several other species. The cDNA for hamster aFGF/HBGF-I was isolated from a DDT-1 lambda gt11 library and sequenced. Comparison of the coding region of aFGF/HBGF-I from four species shows a greater than 90% conservation of amino acid sequence.
Two studies were conducted in an attempt to replicate an earlier finding of self-esteem deficits in adolescent girls with early onset of insulin-dependent diabetes mellitus (IDDM). Participants in Study 1 were 139 adolescents with IDDM who completed the Perceived Competence Scale for Children (Harter, 1979). A 2 (gender) X 2 (group: age of IDDM onset: early vs. late) multivariate analysis of variance (MANOVA) did not reveal a significant interaction effect. Study 2 included 136 adolescents (104 adolescents with IDDM and 32 physically healthy adolescents) who completed the Self-Perception Profile for Children (Harter, 1985). A 2 (gender) X 3 (early IDDM onset, late IDDM onset, physically healthy control) MANCOVA, controlling for the effects of social class and adolescent age, also indicated no significant interaction effect. Thus, we found no differences in self-esteem based on age at disease onset and gender in two independent samples of youths with IDDM. In Study 2, significant gender and group effects were revealed, but when these findings are compared with normative data and data from our physically healthy sample, the results suggest that the youths with IDDM were functioning within the normal range on self-esteem. The importance of these findings in regard to the deficit versus adaptation models of chronic illness is discussed.
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From 1981 to 1988, eighty percent of all women with the acquired immunodeficiency syndrome (AIDS) reported to the Centers for Disease Control were of reproductive age. Six pregnancy-associated deaths due to AIDS in this country have been reported in the medical literature. We identified 20 unpublished cases of women who died of AIDS during or within one year after termination of pregnancy. Analysis showed that these women were mostly black or Hispanic, half were intravenous drug abusers, and most died of Pneumocystis carinii pneumonia. Each pregnancy had an obstetric complication, primarily preterm delivery. The interval between diagnosis of AIDS and the death of these women ranged from one day to 15 months, with a mean interval of 113 days. Multiple reporting sources increased case detection and should be used for future investigations. Prospective case-control studies are needed to determine any further relationship between pregnancy complications and AIDS.
The relationships between two coping styles (i.e., use of personal and interpersonal resources; ventilation and avoidance) and two health outcomes (i.e., adherence and metabolic control) were evaluated in 135 youths with insulin-dependent diabetes mellitus (IDDM). Individual characteristics (i.e., age, duration of illness) and contextual variables (i.e., stress, family relations) were used to predict coping styles. Poor adherence to treatment, older adolescent age, and long duration of IDDM were correlated with ventilation and avoidance coping. Youths with short duration of IDDM were more likely to cope through the use of personal and interpersonal resources, although this strategy was not associated with health outcomes. A multiple regression analysis indicated that high ventilation and avoidance coping was predicted by high stress, low family cohesion, and older adolescent age. In addition, the interaction between family adaptability and duration of IDDM significantly predicted ventilation and avoidance coping.
This study investigated the associations between important dimensions of family relations and the metabolic control of adolescents with insulin-dependent diabetes mellitus (IDDM). Participants were 94 intact families (mother, father, and adolescent) of adolescents with IDDM. Metabolic control was determined by the adolescents' level of HbA(1c), and family relations were assessed with the Marital Adjustment Scale and the Family Adaptability and Cohesion Evaluation Scales-II. Although zero-order correlations showed that good metabolic control was associated with high family cohesion, family flexibility, and high marital satisfaction, hierarchical regression analyses revealed that these associations were considerably attenuated when participant demographic variables, especially the duration of IDDM, were controlled. Follow-up analyses showed that the associations between family relations and metabolic control were mediated by the duration of IDDM. Under conditions of short duration, there were strong associations between family relations and metabolic control. As duration lengthened, however, these associations decreased substantially. These results suggest that the associations between family relations and health are relatively complex in this sample of adolescents with IDDM.
Accurate delivery of low flow oxygen is essential for the management of infants with chronic respiratory failure. Twenty-seven examples of one low flow oxygen meter were tested. Measured flows were found to differ greatly from indicated settings, particularly at 250 mL/min settings. Knowledge of such errors as well as improved quality control are essential for appropriate management of oxygen therapy.
Interstitial pregnancy which resulted in a term, live infant was found in association with pathologic torsion of the uterus. Antenatal sonograms revealed a hypervascular area anterior to the uterus.
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Relaxin-like immunoreactivity was measured in seminal plasma from men who were separated into two groups, on the basis of a previous positive or negative result in a postcoital cervical mucus penetration test. There was no difference in the relaxin concentration between the groups. The effect of exogenous porcine relaxin (0, 10 or 100 ng/ml) on human cervical mucus penetration in vitro by washed human spermatozoa was studied using a capillary tube preparation. In the positive postcoital test group the highest relaxin concentration (100 ng/ml) tended to inhibit cervical mucus penetration, although this effect was only significant for one of the parameters measured (number of spermatozoa penetrating to the 10-mm mark). The same trend was apparent for the negative postcoital test group, but no differences were significant. The results are in direct contrast to previous reports that relaxin can stimulate human spermatozoa motility and cervical mucus penetration.
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Dexamethasone (3.3 X 10(-8) M) potentiated 1-isoproterenol-stimulated adenylated cyclase activity in vitro in rabbit ciliary process epithelial membrane preparations. The ka for isoproterenol stimulation of the cyclase was 5 X 10(-7) M in control membranes, 2.5 X 10(-9) M in membranes preincubated with dexamethasone, and 6 X 10(-8) M with corticosterone. No change was observed in basal adenylate cyclase activity. Changes in enzyme activity at maximally stimulating levels of isoproterenol were not consistently different. Dose response to corticosterone in the presence of 10(-7) M 1-isoproterenol shows maximum effect at 6.6 X 10(-8) M corticosterone.