Correlation between the size of the compound muscle and sensory nerve action potentials recorded from the foot in distal axonopathy.

Nerve conduction study was performed on 71 diabetic patients with distal sensorimotor axonopathy. Of 76 lower limbs studied, 46.1% showed no recordable sural compound sensory nerve action potential (CSNAP), and 55.3% no superficial peroneal CSNAP. Only 2.6% revealed no recordable compound muscle action potential (CMAP) from the abductor hallucis (AH) muscle, and 9.2% showed no obtainable CMAP from the extensor digitorum brevis (EDB) muscle. There were fairly good positive correlations between the amplitudes of the sural CSNAPs and AH CMAPs (r = 0.66), and between the superficial peroneal CSNAP and EDB CMAP amplitudes (r = 0.63). There were no instances in which a CSNAP could be obtained from the sural or superficial peroneal sensory nerve, but a CMAP could not be recorded from the AH or EDB muscle. If the CMAP amplitudes of the AH and EDB muscles were reduced to less than 0.3 mV, usually a CSNAP could longer be recorded from the sural and superficial peroneal sensory nerves. The size of the CSNAP is a more sensitive measure compared to the CMAP in revealing the presence of distal sensorimotor axonopathy.

Evaluation of the ergogenic properties of ginseng: an update.

Ginseng has been used in the Orient for several thousand years as an 'adaptogenic' as well as a 'restorative' agent. It has been used to treat nervous disorders, anaemia, wakefulness, dyspnoea, forgetfulness and confusion, prolonged thirst, decreased libido, chronic fatigue, angina and nausea. Although the mechanisms underlying the alleged effects of ginseng remain to be elucidated, there is an extensive animal literature dealing with the effects of ginseng on the cardiovascular system, central nervous system, endocrine system, metabolism, and immune system. In our previous review dealing with the efficacy of ginseng, we concluded that while studies with animals show that ginseng, or its active components, may prolong survival to physical or chemical stress, there is generally a lack of controlled research demonstrating the ability of ginseng to improve or prolong performance in fatigued humans. In this review, we extend our earlier analysis on the potential efficacy of ginseng use in the enhancement of physical performance and modification of fatigue states. Our analysis reveals that published literature appearing since our earlier review has not resolved the equivocal nature of research evidence involving animals or humans. Also, the lack of unanimity in this research can be explained on the basis of various methodological problems such as inadequate sample size and lack of double-blind, control and placebo paradigms. In addition, the absence of acceptable approaches to the problem of 'sourcing', in concert with an absence of compliance data in human research, further complicates the interpretation of this research literature. Nevertheless, the use of ginseng continues to grow, and current sales are estimated to be over $US300 million annually. There is clearly a need for systematic research dealing with the efficacy of ginseng, and this research needs to take into account basic, fundamental design considerations if there is to be any hope of establishing whether or not ginseng possesses efficacy.

Alabama laws on drug testing in the work place.

Alabama law related to employee work place drug testing consists of the newly enacted drug free work place program, the workers' compensation law and the unemployment compensation law. These laws contain specific requirements relating to the performance of employee drug testing. Physicians will play a key role in the management, supervision and implementation of employer drug testing programs and should become familiar with state and federal laws and regulations pertaining to the operation of those programs.

Prostate specific antigen following radiotherapy for local prostate cancer.

The clinical recurrence-free survival rates were compared to the combined clinical and biochemical recurrence-free survival rates in 285 patients with stages A2 (T1b), B (T2) and C (T3) prostate cancer treated with radiation therapy. For stages A2 (T1b) and B (T2) disease the 10-year clinical recurrence-free survival rate was 48% and the corresponding 10-year clinical and biochemical recurrence-free survival rate was 33%. For stage C (T3) disease these rates were 33% and 22%, respectively. These results demonstrate that approximately a third of the patients who are considered recurrence-free by standard clinical criteria at 10 years after radiation therapy have elevated prostate specific antigen values and are at significant risk for later clinical failure.

Two novel transmembrane protein tyrosine kinases expressed during Caenorhabditis elegans hypodermal development.

We describe our characterization of kin-15 and kin-16, a tandem pair of homologous Caenorhabditis elegans genes encoding transmembrane protein tyrosine kinases (PTKs) with an unusual structure: the predicted extracellular domain of each putative gene product is only about 50 amino acids, and there are no potential autophosphorylation sites in the C-terminal domain. Using lacZ fusions, we found that kin-15 and kin-16 both appear to be expressed during postembryonic development in the large hypodermal syncytium (hyp7) around the time that specific hypodermal cells fuse with hyp7. kin-15 and kin-16 were positioned on the genetic and physical maps, but extrachromosomal arrays containing wild-type kin-15 and/or kin-16 genes were unable to complement candidate lethal mutations. The results suggest that kin-15 and kin-16 may be specifically involved in cell-cell interactions regulating cell fusions that generate the hypodermis during postembryonic development.

Long-term evaluation of radical prostatectomy as treatment for clinical stage C (T3) prostate cancer.

We reviewed the results of radical prostatectomy in 232 patients with clinical Stage C prostate cancer for comparison with published results of irradiation for clinical Stage C patients. Twenty-two percent were Stage B pathologically (i.e., overstaged clinically); 36 percent were pathologic Stage C and 42 percent were Stage D1. Fifty-four percent had had adjuvant treatment immediately postoperatively. Mean follow-up was 4.9 years, with 86 and 32 patients under observation at five and ten years, respectively. Overall, cause-specific, disease-free, and local recurrence-free survival rates were 84 percent, 89 percent, 69 percent, and 90 percent, respectively, at five years, and 72 percent, 82 percent, 56 percent, and 82 percent, respectively, at ten years. Although adjuvant hormonal treatment affected progression significantly (P = 0.0069), it did not affect survival significantly. When the analysis of survival to a female prostate-specific antigen (PSA) level was combined with clinical disease-free survival to provide a more accurate measure of disease progression, 90 percent, 51 percent, and 38 percent of patients with clinical Stage C prostate cancer were free of disease at one, five, and ten years, respectively. The clinical data suggest that radical surgery often combined with immediate adjuvant therapy may provide better disease control (including PSA values) than primary radiotherapy.

Prostate specific antigen values after radical retropubic prostatectomy for adenocarcinoma of the prostate: impact of adjuvant treatment (hormonal and radiation)

Prostate specific antigen (PSA) levels were obtained before and after radical retropubic prostatectomy in 192 patients: 78 (41%) had pathological stage B2 cancer or less, 83 (43%) had stage C or C+ and 31 (16%) had stage D1 disease. Of those with stages B2 or less, C, C+ and D1 disease 82, 86, 65 and 90%, respectively, had postoperative PSA values of 0.2 ng./ml. or less (when first evaluated 30 or more days postoperatively). At 1 year postoperatively 94% of the stages C and C+ cancer patients treated with adjuvant radiation had PSA levels of 0.2 ng./ml. or less, which was significantly different from those not treated adjuvantly (p = 0.02). This effect of adjuvant radiation on PSA was temporary in the small number of patients with longer followup. Adjuvant orchiectomy for stage D1 lesions resulted in female PSA levels in virtually all cases. This decrease may be misleading and may reflect a direct hormonal effect rather than a decrease in tumor volume. Positive surgical margins did not significantly affect postoperative PSA levels, possibly because of the frequent use of adjuvant treatment.

NG-nitro-L-arginine inhibits non-adrenergic, non-cholinergic relaxation in rabbit urethral smooth muscle.

Electrical field stimulation induced a relaxation response in female rabbit urethral smooth muscle strips precontracted with phenylephrine. The relaxation response was inhibited by tetrodotoxin, but not by atropine, propranolol, or hexamethonium. The relaxation response thus results from stimulation of inhibitory non-adrenergic, non-cholinergic nerves. The electrically induced relaxation response was inhibited by an inhibitor of nitric oxide biosynthesis, NG-nitro-L-arginine. This inhibition was overcome by addition of a precursor of nitric oxide, L-arginine. An inhibitor of soluble guanylate cyclase, methylene blue, reduced the relaxation response, and a selective cyclic GMP phosphodiesterase inhibitor, M & B 22948, potentiated the relaxation response. These data indicate that agents which affect the biosynthesis of nitric oxide are associated with the urethral relaxation response evoked by electrical field stimulation, and that cyclic GMP may mediate the relaxation response.

Progression and survival after renal-conserving surgery for renal cell carcinoma: experience in 104 patients and extended followup.

Of 104 patients who underwent a conservative operation for renal cell carcinoma 42 underwent partial nephrectomy, 60 underwent enucleation and 2 underwent a combination of these procedures. A total of 14 patients required an extracorporeal operation with autotransplantation. Forty patients had bilateral renal cell carcinoma (20 were synchronous and 20 were asynchronous) and 39 had either a solitary kidney or a poorly functioning contralateral renal unit. An operation was performed in the presence of a normal contralateral unit in 20 patients. The maximal duration of followup was 20 years (mean 4.9 years): 43, 17 and 7 patients were followed for 5 or more, 10 or more and 15 or more years, respectively. The 5-year cause-specific survival rates were 88.6 +/- 5.6, 91.6 +/- 4.7 and 88.9 +/- 3.8%, respectively, for the enucleation group, partial nephrectomy group and all patients combined. The percentages of patients free of local recurrence at 5 years for the enucleation and partial nephrectomy groups were 94.6 +/- 3.9 and 93.3 +/- 4.7%, respectively. The 14 patients who required an ex vivo approach had larger, higher stage and higher grade tumors, and a poorer outcome (5-year cause-specific survival rate and local rate free of recurrence were 54.9 +/- 17.2 and 85.7 +/- 13.2%, respectively). None of the 20 patients with a normal contralateral unit had progression. The local survival rate free of disease and cause-specific survival rate were not significantly different for the simple enucleation and partial nephrectomy groups. Even longer followup is needed to assess more clearly the definitive role of simple enucleation in the treatment of renal cell carcinoma and the clinical relevance of possible positive margins in a patient population that usually is older.

Prostate-specific antigen testing in untreated and treated prostatic adenocarcinoma.

The isolation and purification of prostate-specific antigen (PSA) and the development of a radioimmunoassay for this antigen represent major advancements for the detection of adenocarcinoma of the prostate and the monitoring of response to therapy in patients with this disease. Both monoclonal and polyclonal assays for PSA are available. In attempts to correlate pathologic tumor stage and PSA levels, tumors of higher stage (pathologic stages C1, C2, D1, and D2) have been associated with elevated PSA levels. Increased PSA levels have also been found in patients with benign prostatic diseases (benign prostatic hypertrophy and prostatitis). PSA has been shown to be an excellent marker after radical prostatectomy and for monitoring of radiation therapy. Patients with a persistently elevated PSA level for more than 6 months postoperatively should be assessed for residual or recurrent local or systemic disease. Thus far, routine use of PSA testing as a mass screening modality for prostatic cancer has not been considered cost-effective.

Three splicing patterns are used to excise the small intron common to all minute virus of mice RNAs.

We identified three splicing patterns used to excise the small intron common to all three transcripts encoded by minute virus of mice. Sequence analysis of minute virus of mice-specific cDNAs indicated that two donor and two acceptor splice sites were used: in pattern 1, the most frequent, nucleotide 2280 was spliced to nucleotide 2377; in pattern 2, nucleotides 2317 and 2399 were joined. Oligonucleotide probes, each specific for one of the four possible splice junction sequences, were synthesized and hybridized to viral mRNAs immobilized on nitrocellulose filters. The probes specific for splice patterns 1 and 2 hybridized to all three viral mRNAs, as did a third oligomer specific for a splicing pattern in which nucleotides 2280 and 2399 were joined. The fourth potential splicing pattern, linking nucleotides 2317 and 2377, was not detected. The presence of three splicing patterns in the transcripts designated R2 and R3 would allow the translation of five distinct polypeptides from these two mRNAs.

Perinephric and intrarenal abscesses.

Perinephric and intrarenal abscesses remain a significant source of morbidity and mortality as well as a diagnostic dilemma. The history, epidemiology, disease classification, etiology, diagnosis, and treatment are reviewed, with special attention to new diagnostic and treatment modalities.

Transcripts of human HLA gene fragments lacking the 5'-terminal region in transfected mouse cells.

Clones of mouse L cells transfected with a human HLA-B7 gene fragment lacking the 5' segment of exon 2 and all upstream sequences express HLA-specific transcripts of various lengths. These include species that correspond in size to full-length HLA-B7 mRNA. The level of these transcripts is increased in cells treated with interferon. It is probable that the full-length transcripts arise as a result of the linkage of the HLA-B7 gene fragments with DNA segments providing transcription initiation or polyadenylylation signals.