Effects of captopril on survival in patients with heart failure.

Results from a large multicenter study and from the published literature suggest that captopril can improve survival in patients with advanced heart failure. The survival status of 105 patients with moderately severe heart failure who participated in a multicenter, double-blind comparison of captopril and placebo therapy was ascertained on an intention-to-treat basis. During the 90-day double-blind portion of this study, 21 percent (11 of 52 patients) of placebo-assigned patients died compared with four percent (two of 53 patients) of captopril-assigned patients (p less than 0.01). In addition, six previously published studies that provided comparative mortality data were identified. In one of these, the survival rate was reported to be improved in those who received captopril; in the other five studies, no conclusion could be drawn with respect to survival since death was an infrequent event within all treatment groups. Mechanisms by which captopril may improve survival include its favorable effects on hemodynamic parameters, its association with reduced ventricular ectopic activity, and its inhibitory effects on the renin-angiotensin and sympathetic nervous systems.

Calf enlargement from S-1 radiculopathy. Report of two cases.

Two patients with painless hypertrophy of one calf had clinical and myelographic features compatible with an S-1 radiculopathy. Electromyographic studies revealed intermittent spontaneous discharges (bizarre repetitive potentials) in the affected extremity. Several patients have previously been described with S-1 radiculopathy and calf hypertrophy with or without spontaneous electrical activity. The hypertrophy in the two present cases could have been caused by continuous stretching (both patients were very active), by the abnormal electrical activity, or by a combination of the two. A neurogenic lesion must be excluded in patients with isolated hypertrophy of a calf muscle, even in the absence of radicular pain.

Unblocking brainstorms.

Brainstorming groups have consistently produced fewer ideas than have the equivalent number of individuals working by themselves. These results have been attributed to social loafing, evaluation apprehension, and production blocking in groups. In this study, a new brainstorming technique--electronic brainstorming--that may reduce both production blocking and evaluation apprehension was assessed. Electronic and nonelectronic groups and nominal and interacting groups were compared in a 2 x 2 factorial design. Electronic groups were more productive than nonelectronic groups, but the productivity of nominal and interacting groups did not differ. In contrast, interacting groups felt better about the idea-generation process than did nominal groups. Ways in which electronic brainstorming can reopen a long dormant area of research and application are discussed.

The efficacy of a potassium-sparing combination of chlorthalidone and triamterene in the control of mild and moderate hypertension. II.

Chlorthalidone 50 mg/triamterene 50 mg in once-daily oral doses was as effective in reducing blood pressure as chlorthalidone 50 mg alone. The decrease in serum potassium was statistically significantly less with the combination than for chlorthalidone. There were no notable differences between the treatments in any other measure of laboratory safety or adverse reaction.

The social image of the young female smoker.

Community college students (N = 229) read a brief narrative about a young female college student and rated her on 14 bipolar scales. Half the subjects read a version in which the protagonist smoked, and half an otherwise identical version in which she didn't. Although most subjects recalled the protagonist's smoking status, very few recognized this as the focal variable in the experiment. Subjects rated the heroine less positively for social attractiveness (p less than 0.001) and personal resourcefulness (p less than 0.01) when she was represented as a smoker. They specifically considered the smoking protagonist more masculine (p less than 0.01), less feminine (p less than 0.001), less healthy (p less than 0.001), a poorer student (p less than 0.001), less wise (p less than 0.001), less self-disciplined (p less than 0.001), less sophisticated (p less than 0.001), and less gentle (p less than 0.02). Non-smoking subjects also rated the smoking heroine as less (physically) attractive (p less than 0.05), although smoking subjects did not discriminate significantly.

The cost of monitoring medical care in Pennsylvania.

We estimated the cost of the Health Care Cost Containment Act in Pennsylvania to be over $19 million; the yearly direct cost of KePRO activities to be over $14 million; and compliance costs for peer review to possibly be as large as $27 million, based on our high estimate. We also found that medical records, utilization review and administrative departments in Pennsylvania hospitals have collective annual budgetary expenditures of close to $2.4 billion. In addition, we estimated Pennsylvania physicians to spend from $14 million to $17 million each year on administrative and fiscal activities related to reimbursement. Our cost estimates for non-clinical expenditures were based on the best data available at the time, though in many cases this data was crude. However, we believe that this data is a useful starting place for a dialogue about the cost and effectiveness of these programs. In reporting the cost of these activities it was not our intent to judge the value of any individual program. Instead we hope that we have taken a first step in the process of collecting cost data so that actual costs for non-clinical activities can be appropriately evaluated. Future studies of non-clinical expenditures should not only include direct program expenditures but also the economic impact on providers in complying with the mandates. Finally, efforts to reduce duplicate and unproductive regulatory programs will be necessary in working toward a cost-efficient system. Legislative efforts, such as the Physician Regulatory Relief and Improvement Act (H.R. 4475 and S.B 2051), aimed at the so called "hassle factor" will be helpful.

Measurement of fecal lactoferrin as a marker of fecal leukocytes.

While diarrheal illnesses are extremely common in communities and hospitals throughout the world, an etiologic diagnosis may be expensive and cost-ineffective. Although the presence of fecal leukocytes are helpful in the diagnosis and specific therapy of inflammatory diarrheas, this requires prompt microscopic examination of fecal specimens (preferably obtained in a cup rather than a swab or diaper) by a trained observer. We developed a simple, sensitive test for the detection of leukocytes in fecal specimens using antilactoferrin antibody. Whereas radial immunodiffusion detected 0.02 micrograms of lactoferrin (LF) per microliter or greater than or equal to 2,000 leukocytes per microliter, latex agglutination (LA) readily detected greater than or equal to 0.001 micrograms of LF per microliter or greater than or equal to 200 leukocytes per microliter added to stool specimens. Despite the destruction or loss of morphologic leukocytes on storage for 1 to 7 days at 4 degrees C or placement of specimens on swabs, measurable LF remained stable. Initial studies of stool specimens from six patients with Salmonella or Clostridium difficile enteritis were positive and those from three controls were negative for LF by LA. Of 17 children in Brazil with inflammatory diarrhea (greater than or equal to 1 leukocyte per high-power field), 16 (94%) had LF titers of greater than 1:50 by LA, whereas only 3 of 12 fecal specimens with less than 1 leukocyte per high-power field on methylene blue examination and none of 7 normal control specimens had an LF titer of greater than 1:50 by LA. Of 16 fecal specimens from patients with C. difficile diarrhea (cytotoxin titers, >/= 1:1,000), 95% (n = 15) had detectable LF by LA (in titers of 1:100 to 1: 800). Finally, of 48 fecal specimens from healthy adult U.S. volunteers before and after experimental shigellosis and of 29 fecal specimens from children with documented shigellosis and hospitalized controls in northeastern Brazil, fecal LF titers ranged from 1:200 to >/= 1:5,000 in 96% (25 of 26) samples from patients with shigellosis (and reported positive for fecal leukocytes), while 51 controls consistently had fecal LF titers of

A radioimmunoassay method for the rapid detection of Candida antibodies in experimental systemic candidiasis.

Rabbits were employed as experimental models to evaluate a solid-phase radioimmunoassay (RIA) method for the diagnosis of systemic candidiasis. Ten rabbits were inoculated subcutaneously to mimic superficial candidiasis and were found to produce no antibodies to Candida as determined by both immunodiffusion and RIA procedures. However, 94 per cent of 18 rabbits systemically infected by intravenous injection of Candida cells were observed to produce antibody as assessed by the RIA technique. These data encourage further tests with human sera and the continued development ofthis RIA procedure as a useful tool in the early serodiagnosis of systemic candidiasis.