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PubMed1984

Homogeneous enzyme immunoassay for cortisol with a centrifugal analyzer.

We determine serum cortisol by a homogeneous enzyme immunoassay in the Cobas Bio centrifugal analyzer. To unbind cortisol from its protein complex, serum is treated for 15 min with an acidic solution. The reaction then proceeds automatically in the analyzer at 37 degrees C. To 50 microL of sample mixture is added 125 microL of reagent (cortisol antibodies, glucose 6-phosphate, and NAD+). This mixture is incubated for 60 s, after which 25 microL of a cortisol derivative labeled with glucose 6-phosphate is added; the increase in absorbance is monitored at 340 nm. The standard curve was linear from 10 to 500 micrograms of cortisol per liter. Within-assay precision (CV) varied from 0.2 to 0.6%, between-assay precision from 6.2 to 10.6%. Analytical recovery ranged from 100 to 103%. Results for control samples deviated from target values by 1.4 to 7.8%. Results compared well with those by radioimmunoassay. The method is reliable and practicable and will usefully replace previous routine methods for serum cortisol.

Autoanalysis↗

PubMed1983

Delusional depression and inappropriate antidiuretic hormone secretion.

Two cases of delusional major depression associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) are described. Delusional depression and SIADH may both result from alterations of brain catecholamine neurotransmitters, and may coexist more commonly than previously thought. Implications for clinical practice and future research are discussed.

Aged↗

PubMed1983

[Psychiatric emergencies in childhood and adolescence].

The referrals for urgent psychiatric treatment were studied systematically to improve our understanding of the acute forms of psychological distress in children and adolescents and the crisis situations which disrupt the usual relationships between the child and his family. During the last 12 months, 212 requests for urgent psychiatric opinion in children under 18 years of age were received. The following points were analyzed: --general: age, sex, geographical distribution of the patients and their families, present family conditions, socio-economic class, origin of the urgent referral; --psychological or psychopathological: presenting symptoms, organisation of the personality of the child or adolescent, previous psychological or psychiatric history; --practical: the emergency management, ulterior orientation. The authors conclude with some remarks on the possible lines of action in the emergency situations.

Acute Disease↗

PubMed1983

The recirculating lymphocyte pool of the rat: a systematic description of the migratory behaviour of recirculating lymphocytes.

A comprehensive study of lymphocyte traffic in AO rats was performed under conditions as near to the physiological state as was practicable. In the light of previous results on the effect of environmental factors on the migratory behaviour of lymphocytes, thoracic duct cells were passed from blood to lymph in an intermediate rat before injection into a series of recipients for examination at time intervals from 1 min to 24 hr. At 1, 2 and 5 min after injection most of the labelled cells were in the blood, lungs and liver. The concentrations in these compartments fell over the next 25 min as the cells entered the spleen, lymph nodes (LN) and Peyer's patches according to a regular pattern. The peak localization in these latter organs occurred between 1 hr and 18 hr. Each organ had a characteristic time pattern of lymphocyte localization. Entry into mesenteric LN lagged behind other LN until 2.5 hr after injection following which mesenteric LN localization easily outstripped that in other LN to reach a delayed peak at 18 hr. Intravenously injected lymphocytes began to reappear in thoracic duct lymph in large numbers earlier than in previous studies so that the time taken for most T lymphocytes to cross LN from blood to lymph fell within the broad time band of 4-18 hr. Lymphocytes took on average 5-10 min to cross high endothelial venules when entering LN from the blood.

Animals↗

PubMedDate not supplied

Inhibition of 3 beta-hydroxysteroid-dehydrogenase: an approach for prostate cancer treatment?

Over 80% of clinically manifested prostate cancers respond to androgen withdrawal. Several alternatives to castration have been explored. Since a growth promoting role for androstenedione has been suggested, we investigated the effect of inhibition of 3 beta-hydroxy-steroid-dehydrogenase (3 beta-HSD), a key enzyme involved in the biosynthesis of practically all steroids. In a previous study a reduced proliferation rate of androgen responsive R3327-H tumor was demonstrated after in vivo treatment with 17 beta-N,N-diethylcarbamoyl-4-aza-5 alpha-androstan-3-one (4MA) - a putative 5 alpha-reductase inhibitor. In the present investigation 3 beta-HSD enzyme activity derived from human placenta, testis and ovarian cancer cell line and from rat testis was determined using radiolabeled dehydroepiandrosterone (DHEA) or pregnenolone. Among different synthetic compounds known to interfere with steroidogenesis, only 4MA was shown to potently inhibit in vitro 3 beta-HSD activity from all tissue sources. 4MA was administered to male Copenhagen rats bearing R3327-H androgen dependent prostate tumors and levels of different androgens in serum and prostate tumor were measured using reversed phase HPLC and radioimmunoassay. The decreased content of androstenedione in serum and tumor tissue with DHEA accumulation in prostate tumor tissue showed an effective 3 beta-HSD inhibition by 4MA occurring in vivo as well. These observations unequivocally demonstrate a 3 beta-HSD inhibiting effect of 4MA in vitro as well as in vivo and point to a role for androstenedione in the promotion of cell proliferation in androgen sensitive tumors. 3 beta-HSD dependent androstenedione production could thus constitute a proper target -eventually combined with other endocrine treatment - for the treatment of hormone dependent prostate cancer.

3-Hydroxysteroid Dehydrogenases↗

PubMed1995

Incidence and risk factors for human T-lymphotropic virus type II seroconversion among injecting drug users in Baltimore, Maryland, U.S.A.

To determine the incidence of and risk factors for human T-lymphotropic virus, type II (HTLV-II) seroconversion among injecting drug users (IDUs), specimens from IDUs recruited into the ALIVE Study in 1988/1989 were assayed at baseline for antibody to HTLV with use of enzyme immunoassay and Western blot. Participants were monitored semiannually with venipuncture and interviews. In 1992, the most recent sera of HTLV-negative participants were tested for HTLV with use of enzyme immunoassay and confirmed and typed by Western blot. For positive cases, assays were then performed for all intervening visits to determine the calendar time of seroconversion. Incidence rates were estimated using person-time. Risk factor analysis used a nested case-control design, with up to seven controls per case matched by time of study entry and duration of follow-up. At baseline, 251 HTLV-positive, 22 indeterminate, and 2,574 HTLV-seronegative IDUs were identified. Follow-up of the seronegative IDUs identified 38 seroconverters (all HTLV-II) over 5,813.6 person-years, for a rate of 0.7/100 person-years. Median lag time for seroconversion was 6.8 months. Factors associated with HTLV-II seroconversion included a specific needle-sharing practice called "backloading" within the previous 6 months [odds ratio (OR) = 6.52; 95% confidence interval (CI) = 1.94-21.95] and a baseline history of receiving money for sex (OR = 3.36; 95% CI = 1.32-8.57). Of those with more than one sex partner in the past 6 months, women were more likely than men to seroconvert (OR = 5.77; 95% CI = 1.33-25.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Primary care orthopedics and sports medicine in West Virginia.

Previous studies at several family practice residency programs in the U.S. have shown that many family practice graduates feel inadequately prepared to offer fracture care or casting. In order to determine if this was a problem in West Virginia, a survey was sent to all family physicians in the state which asked about their type of practice and residency training, if they provided fracture care or casting services, if they offered sports medicine coverage for teams in their communities, attitudes about their own competency in caring for fractures, as well as other personal and demographic data. Our survey confirmed that only 118 family physicians provide fracture care (42%), and that only 91 provide casting services (32%). The surveys also revealed that rural physicians feel obligated to offer this service, despite the fact that they do not perceive themselves to be very competent in this aspect of patient care, and only 43 rural physicians offer sports medicine coverage (44%). As a result of these findings, we propose that a more adequate orthopedic experience be a part of family practice training, and that there should also be increased emphasis on insuring family practice residents have a basic competency in sports medicine.

Adult↗

PubMed1994

[Nutritional support in oncology. The outpatient].

The process of tissue regeneration and healing requires individualized nutrition, often with dietary manipulation of regular foodstuffs and supplements to prevent or correct previous or iatrogenic deficiencies. A practical approach to problem-solving in order to provide the best possible nutritional support at home is presented.

Ambulatory Care↗

PubMed1993

Quality of laboratory performance in testing for human immunodeficiency virus type 1 antibody. Identification of variables associated with laboratory performance.

To identify factors that may affect the quality of laboratory performance of human immunodeficiency virus type 1 (HIV-1) antibody testing, the Centers for Disease Control and Prevention Model Performance Evaluation Program surveyed laboratories in 1989 that performed enzyme immunoassay (EIA) and Western blot tests for HIV-1 antibody. Panels of 10 HIV-1-antibody-positive and antibody-negative plasma samples, some of which were duplicates, were mailed to program-participating laboratories. Laboratories were also mailed survey questionnaires to ascertain their laboratory characteristics and testing practices. Using 1988 data, researchers previously found that the overall analytic performance of laboratories performing HIV-1 antibody testing was independently associated with the following: (1) requiring a minimum degree of testing personnel; (2) having written criteria for identifying unsatisfactory specimens; (3) requiring in-house training for testing personnel; (4) having tested more than 10,000 specimens; (5) being identified as an "other" laboratory type; (6) having more than 24 months of testing experience; (7) laboratory uses specific (Abbott) materials for EIA; and (8) testing specimens collected by family-planning clinics. To verify these findings, we performed multivariate analysis on 1989 performance data. For the 1989 EIA analytic sensitivity, significant positive (P < or = .05) associations were detected with having written criteria for identifying unsatisfactory specimens and with having tested more than 10,000 specimens. For the 1989 overall EIA analytic performance, a significant negative (P < or = .05) association was found with using specific (Abbott) EIA materials, and a significant positive (P < or = .05) association was found with having tested more than 10,000 specimens. For Western blot results, the only significant (P < or = .05) associations were for both analytic sensitivity and overall analytic performance and having tested more than 10,000 specimens.

Blotting, Western↗

PubMedDate not supplied

Hypertension in the 1990s: a new disease.

BACKGROUND: Recent analyses of the cumulative results of the major treatment trials of mild-to-moderate hypertension have shown only a small benefit in the prevention of stroke and no benefit in the prevention of coronary heart disease. METHODS: A MEDLINE search for articles published from 1966 to 1991 was made using the key words "left ventricular hypertrophy," "hypertension," "insulin resistance," and "cholesterol." The bibliographies of these articles and articles previously abstracted in The Family Practice Newsletter (InforMed) and the author's personal files were also sources of information. RESULTS AND CONCLUSIONS: Newer pharmacologic agents for hypertension, the peripheral alpha-blockers, the calcium channel blockers, and angiotensin converting enzyme inhibitors, exert positive effects on left ventricular hypertrophy, serum lipids, and serum insulin and could be cardioprotective. These drugs offer the promise of being able to show cardiovascular benefits from the treatment of mild-to-moderate hypertension that were not realized in the earlier clinical trials.

Antihypertensive Agents↗

PubMed1996

Titanium-anchored prostheses in otology.

In the late 1970s, Per-Ingvar Branemark and coworkers in Goteberg, Sweden, successfully introduced osseointegrated titanium implants into clinical practice. They had achieved the previously elusive goal of producing stable, secure percutaneous implants anchored in underlying cortical bone. Two applications of these implants to otology were obvious: (1) to provide a coupling for bone-conduction hearing aids and (2) to provide fixation points for anchoring of auricular prostheses. Before describing the current state of these clinical applications and considering future potential uses, the authors review the basis for titanium osseointegration.

Bone Conduction↗

PubMed1996

Allied health faculty attitudes toward rural clinical practice.

Research findings of allied health practitioners' attitudes toward rural practice are limited. The purpose of this study was to identify attitudes of faculty members in a school of allied health toward rural vs. urban living, clinical education, and practice. A survey consisting of demographic and attitudinal questions was mailed to 233 faculty representing five professions. The response rate was 63.5%. The majority viewed rural living as having both positive and negative aspects. Placement of clinical students in rural areas was seen as enhancing rural recruitment. Rural professional issues were viewed as mixed with the most positive aspect being greater intellectual challenge. There were a few significant attitude differences by gender, age, years of experience, profession, hometown location, and practice location site. The findings of this study generally support previous research and contribute additional knowledge regarding attitudes toward rural practice. Further studies of allied health professionals appear warranted.

Allied Health Personnel↗

PubMed1996

Predictive properties of serum-prostate-specific antigen testing in a community-based setting.

BACKGROUND: Most studies that have described the sensitivity and specificity of prostate-specific antigen (PSA) as a screening test have been conducted in urology practice settings or in media-based screening programs. The control patients from these settings may have a higher prevalence of urologic disorders that increase serum PSA levels than that of the general population in which screening efforts might take place, leading to biased estimates of sensitivity and specificity. OBJECTIVE: To determine the sensitivity and specificity of serum PSA levels for the early detection of prostate cancer in a population-based setting. PATIENTS AND METHODS: This population-based case-control study was conducted in Olmsted County, Minnesota, where the Rochester Epidemiology Project could identify all incident cases of prostate cancer through passive surveillance of medical care provided to local residents. Case patients were all 177 men (age range, 50-79 years) who were newly diagnosed as having prostate cancer from 1990 through 1992 and had a prediagnostic serum PSA determination (90% of all incident cases). Control patients were randomly selected from the Olmsted County population and had undergone a clinical examination to exclude prostate cancer. RESULTS: The median (25th and 75th percentiles) of serum PSA levels was 9.4 ng/mL (5.4 and 18.6 ng/mL, respectively) for case patients and 1.2 ng/mL (0.7 and 2.1 ng/mL, respectively) for control patients (P < .001). When sensitivity was plotted against 1-specificity, the area under the receiver operating characteristic curve was 0.94 (SE, 0.01). The predictive power declined somewhat with age, with areas under the curve of 0.96, 0.94, and 0.90 for men in their 50s, 60s, and 70s, respectively. When cases were restricted to the 155 men with clinically localized disease, the area under the curve was essentially unchanged (0.94; SE, 0.01) and still much greater than the estimates of 0.75 that were reported from urology practice- and media-based settings. CONCLUSIONS: In a community-based setting, serum PSA levels provide better discrimination between men with and without clinically localized prostate cancer than has been observed in studies that were conducted in urologic practices. These results suggest that previous decision analyses may have underestimated the predictive value of PSA for the detection of prostate cancer in a primary care or community-wide screening program.

Age Factors↗

PubMed1997

Demonstration of rectosigmoid fistula dynamic scintigraphic peritoneography.

Intraperitoneal installation of chemotherapy through a Mediport implanted subcutaneously in the abdominal wall is used currently for treatment of peritoneal metastases from ovarian, gastric and colonic carcinoma. There is a variable incidence of complications due to the procedure reported in the literature. The main predisposing factor for these complications is the inhomogeneous distribution of the chemotherapeutic drugs within the peritoneal cavity. We report an unusual case of a rectosigmoid fistula that developed 6 wk following the insertion of a Bardport subcutaneously in the abdominal wall for intraperitoneal therapy. The fistula was clearly demonstrated by dynamic scintigraphic peritoneography. This is a new modification of scintigraphic peritoneography as practiced routinely. We endorse the previous recommendation that scintigraphic peritoneography be performed before every intraperitoneal installation of a chemotherapeutic drug or radiopharmaceutical to ensure the homogeneous distribution of the drugs and to prevent complications.

Aged↗

PubMed1985

Polymyalgia rheumatica/giant cell arteritis in a Cambridge general practice.

The aim of this study was to establish the incidence and prevalence of polymyalgia rheumatica/giant cell arteritis in general practice. Patients with this disorder, whether previously diagnosed or not, were ascertained by using a questionnaire administered by interview, and all received full clinical and laboratory assessment. A total of 579 patients aged 65 and over was seen, and 19 (33/1000) had been diagnosed or developed symptoms within the previous eight years. Thus the calculated annual incidence in those aged 65 and over was about 4/1000. The figures from this first large scale study of polymyalgia rheumatica/giant cell arteritis in general practice are much higher than those from studies carried out in hospital. The questionnaire was effective in both identifying known cases of polymyalgia rheumatica/giant cell arteritis and detecting new cases. As this is a treatable disorder, it is important that doctors become aware of how common it is in elderly people.

Aged↗

PubMed1999

Speech and oral motor learning in individuals with cerebellar atrophy.

The purpose of this study was to determine whether cerebellar pathology interferes with motor learning for either speech or novel tasks. Practice effects were contrasted between persons with cerebellar cortical atrophy (CCA) and control participants on previously learned real speech, nonsense speech, and novel nonspeech oral-movement tasks. Studies of limb motor learning suggested that control participants would evidence reduced variability, increased speed of movement, and reduced movement amplitude with practice as compared with the CCA group. No significant differences were found between the real- and nonsense-speech tasks. For both speech tasks, although neither group reduced their movement variability with practice, both groups significantly reduced jaw closing displacement and velocity with practice. For the novel nonspeech oral-movement task, no change with practice was observed in either group in terms of variability, amplitude, or peak velocity. No effects of cerebellar pathology were seen in either the speech- or oral-movement tasks. These results demonstrated that with practice of speech tasks, a previously learned motor skill, movement speed and displacement decreased in both groups. Therefore, the effects of practice differed between previously learned speech tasks and the novel oral-movement task regardless of cerebellar pathology.

Adult↗

PubMed1999

The role of nursing partnership interventions in improving the health of disadvantaged women.

This paper describes a project which assessed the contribution that nursing professionals are making to improving the health of deprived women living in Northern Ireland. The study is set within the context of the Targeting Health and Social Need (THSN) Initiative an important theme within the Northern Ireland Regional Strategy entitled Health and Well-being into the Next Millennium - A Regional Strategy for Health and Social Well-being 1997-2002 which is concerned with addressing inequalities in health status and social well-being. The paper describes the results of a survey (n=1,000, response rate 39%) and the criteria used to select 22 interventions to provide evidence of 'effective practice' within THSN. The study highlights the work of previous reviews in the area and provides evidence concerning effective interventions in practice. Although the interventions described may be lacking in 'pure scientific' method and may not meet the rigorous inclusion criteria of systematic review methodologies, there is evidence to suggest that nurses are using well-designed more qualitative evaluation methods and demonstrating improvements in health and social need for women in the lowest socio-economic groups. In terms of equity the case studies show that community nursing may be a powerful vehicle for researching people previously neglected by the formal health care system. Health policies such as THSN can now articulate the methods needed for reform or change, setting directions and articulating the barriers to implementation and achievement.

Attitude of Health Personnel↗

PubMed1989

Vaginal birth after cesarean section. Experience in a community-based practice.

The option of vaginal birth after a previous cesarean section (VBAC) is widely recognized as a safe procedure for mother and infant as well as a means of reducing the cesarean section rate. Nevertheless, it remains underutilized in community, non-level III hospitals, where most births occur. Over a 30-month period, all patients presenting to a community-based practice who met the criteria for VBAC as outlined by the American College of Obstetricians and Gynecologists were offered this option. Of 72 candidates, 66 chose a trial of labor; only 4 failed to deliver vaginally. No complications were noted in any of the women or infants. This study demonstrated that in a community setting, VBACs are safe and can yield a high success rate.

Cesarean Section↗