A new paradigm (Westphal-Paradigm) to study the neural correlates of panic disorder with agoraphobia.

Agoraphobia (with and without panic disorder) is a highly prevalent and disabling anxiety disorder. Its neural complexity can be characterized by specific cues in fMRI studies. Therefore, we developed a fMRI paradigm with agoraphobia-specific stimuli. Pictures of potential agoraphobic situations were generated. Twenty-six patients, suffering from panic disorder and agoraphobia, and 22 healthy controls rated the pictures with respect to arousal, valence, and agoraphobia-related anxiety. The 96 pictures, which discriminated best between groups were chosen, split into two parallel sets and supplemented with matched neutral pictures from the International Affective Picture System. Reliability, criterion, and construct validity of the picture set were determined in a second sample (44 patients, 28 controls). The resulting event-related "Westphal-Paradigm" with cued and uncued pictures was tested in a fMRI pilot study with 16 patients. Internal consistency of the sets was very high; parallelism was given. Positive correlations of picture ratings with Mobility Inventory and Hamilton anxiety scores support construct validity. FMRI data revealed activations in areas associated with the fear circuit including amygdala, insula, and hippocampal areas. Psychometric properties of the Westphal-Paradigm meet necessary quality requirements for further scientific use. The paradigm reliably produces behavioral and fMRI patterns in response to agoraphobia-specific stimuli. To our knowledge, it is the first fMRI paradigm with these properties. This paradigm can be used to further characterize the functional neuroanatomy of panic disorder and agoraphobia and might be useful to contribute data to the differentiation of panic disorder and agoraphobia as related, but conceptually different clinical disorders.

O6-Alkylguanine-DNA alkyltransferase in normal colon tissue and colon cancer.

O6-Alkylguanine-DNA alkyltransferase (AGT) is a DNA repair protein that reverses alkylation damage produced by chloroethylnitrosoureas and is a major determinant of cellular resistance to adjuvant chemotherapy with these drugs. AGT activity was measured in 119 samples from 69 patients, including normal, tumor, and diseased tissue, and 42 patients in which both normal and tumor tissue were assayed. The activity varied among individuals, but there was no statistically significant difference in average AGT activity among tumor, normal, and diseased tissue, or between men and women, or between young and old patients (< 70 or > 70 years). Few (3/49) tumor samples showed an absence of AGT activity (Mer- phenotype). The results indicate that nearly all colon cancers have significant AGT activity, and adjuvant chloroethylnitrosoureas chemotherapy must be modified, perhaps by the use of AGT biochemical modulators, to overcome this natural drug resistance.

Patient satisfaction with diagnostic cardiac catheterization: ambulatory vs. inpatient performance.

In a combined retrospective and historical cohort analysis, 72 patients at The Mount Sinai Hospital were studied to assess satisfaction with diagnostic cardiac catheterization and coronary arteriography performed as an ambulatory procedure (40 patients) and as an inpatient procedure (32 patients). A composite questionnaire designed to measure patient satisfaction was generated by the method of summed ranks, a common method of pooling aspects from several sources. Ten psychosocial dimensions of patient satisfaction were explored to determine if any difference existed between the ambulatory-patient population and the inpatient population. The ambulatory-patient group had a higher total mean satisfaction score than the inpatient group (4.01 vs. 3.60, p less than .001). Analysis of the specific dimensions showed that the ambulatory group had mean satisfaction scores higher than those of the inpatient group in convenience of procedure (4.12 vs. 3.13), continuity of care (3.83 vs. 3.42), technical quality (4.85 vs. 4.05), interpersonal aspects of communication (4.53 vs. 4.01), physical environment (4.14 vs. 3.18), and global satisfaction (4.71 vs. 4.25). These differences were statistically significant using the two-tailed t test (t greater than t.05,70 = 1.994). These data suggest that cardiac catheterization performed as an ambulatory procedure yields greater satisfaction than when performed as an inpatient procedure. This fact, in combination with prior published conclusions that ambulatory cardiac catheterization is more cost effective and has a statistically similar complication rate, supports the recommendation that this procedure be performed as an ambulatory procedure.

Evaluating companion planting and non-host masking odors for protecting roses from the Japanese beetle (Coleoptera: Scarabaeidae).

Effectiveness of companion planting, and use of nonhost masking odors were evaluated under field conditions for protecting roses against the Japanese beetle, Popillia japonica Newman. Three reputedly effective companion species, rue (Ruta graveolens L.), zonal geranium (Pelargonium x hortorum Bailey), and garlic chives (Allium scheonparum L.) were interplanted with roses in replicated garden plots. Numbers of beetles on these roses were compared with rose-only control plots on 6 d during beetle flight. The masking odor hypothesis was tested by hanging mesh bags of aromatic herbs or other sources of reputedly repellent nonhost volatiles around potted roses in the field. Treatments included crushed red pepper (Capsicum frutescens L.), fennel seeds (Foeniculm vulgare Miller), crushed spearmint (Mentha picata L.), cedar shavings (Juniperus sp.), osage orange fruits (Maclura pomifera (Raif) Schneid.), and fleshy gingko seeds (Gingko biloba L.). No treatment significantly reduced numbers of beetles relative to the controls. Interplanting with geraniums significantly increased numbers of Japanese beetles on roses. Similarly, roses surrounded by sachets with fennel seeds, cedar shavings, crushed red pepper, or osage orange fruits had significantly more beetles than the control plants on two or more sample dates. Our results suggest that the use of companion or reputedly repellent plants or plant odors probably will be ineffective for protecting roses or other highly-susceptible ornamentals from P. japonica. Use of such tactics in an effort to discourage other garden pests might even increase Japanese beetle damage in those plantings.

Lethal and sublethal effects of bendiocarb, halofenozide, and imidacloprid on Harpalus pennsylvanicus (Coleoptera: Carabidae) following different modes of exposure in turfgrass.

Routes by which nontarget predatory insects can be exposed to turfgrass pesticides include topical, residual, and dietary exposure. We used each of these routes to evaluate potential lethal or sublethal effects of two novel turfgrass insecticides, imidacloprid and halofenozide, and a carbamate, bendiocarb, on survival, behavior, and fecundity of the ground beetle Harpalus pennsylvanicus DeGeer. Field-collected carabids were exposed to direct spray applications in turf plots, fed food contaminated by such applications, or exposed to irrigated or nonirrigated residues on turf cores. Halofenozide caused no apparent acute, adverse effects through topical, residual, or dietary exposure. Moreover, the viability of eggs laid by females fed halofenozide-treated food once, or continuously for 30 d, was not reduced. In contrast, topical or dietary exposure of carabids to bendiocarb inevitably was lethal. Exposure to imidacloprid by those routes caused high incidence of sublethal, neurotoxic effects including paralysis, impaired walking, and excessive grooming. Intoxicated beetles usually recovered within a few days in the laboratory, but in the field, they were shown to be highly vulnerable to predation by ants. One-time intoxication by imidacloprid did not reduce females' fecundity or viability of eggs. There was no apparent behavioral avoidance of insecticide residues, or of insecticide-treated food. Carabids exposed to dry residues on turfgrass cores suffered high mortality from bendiocarb, and some intoxication from imidacloprid, but these effects were greatly reduced by posttreatment irrigation. Implications for predicting hazards of insecticides to beneficial invertebrates in turfgrass are discussed.

Modified atmosphere treatments as a potential disinfestation technique for arthropod pests in greenhouses.

Incidental transport of arthropods on plant material can be a significant mode of pest entry into greenhouses. We evaluated the use of controlled atmosphere treatments as a potential way to eliminate arthropod pests on plant propagules (i.e., cuttings or small rooted plants). Lethal exposures to CO2 or N2 were determined for common greenhouse pests including fungus gnat larvae, Bradysia sp.; green peach aphid, Myzus persicae (Sulzer); sweetpotato whitefly, Bemisia sp.; twospotted spider mite, Tetranychus urticae Koch; and western flower thrips, Frankliniella occidentalis (Pergande). We also studied the effect of pest species, life stage, and presence or absence of plants on efficacy of modified atmosphere treatments. Finally, effects of modified atmospheres on plant quality were evaluated for several bedding plant species including begonia, Begonia semperflorens-cultorum Hort. 'Cocktail Series', chrysanthemum, Dendranthema grandiflora Tzvelev., geranium, Pelargonium X hortorum L.H. Bailey, and impatiens, Impatiens wallerana Hook f., and among cultivars of geranium and chrysanthemum. Exposure for 12-18 h to >99% N2 or CO2 caused complete mortality of aphids, mites, thrips, and whiteflies. Fungus gnat larvae were more tolerant of hypoxic conditions. Adult mites and eggs were equally susceptible. For most pests, there was no difference in response to atmospheres modified by CO2 or N2. However, there was variation in response among plant species and cultivars, with effects ranging from delayed flowering to mortality. Despite the possibility of adverse effects on some plants, this work indicates that use of modified atmospheres has potential to eliminate arthropod pests on plant propagules before they are introduced into greenhouses.

Home management of the adult patient with leukemia.

The many changes that have occurred within the medical profession and among the public are taking long-term care out of the hospital and placing it back into the home. Attitudes toward cancer have altered, as seen by the rapid growth of the oncology specialty as well as the willingness of the community to allow those with cancer to return to a viable status. Even the individual who must face end-stage disease can now rest comfortably in the privacy of his or her own home, surrounded by loved ones. Improved nutritional efforts during periods of active therapy are reducing the side effects and improving the tolerance of highly cytotoxic drugs. Thus, acute episodes of treatment are shortened, allowing for earlier discharge. Individuals are demanding accurate information regarding their disease and its treatment. Patients are catalysts for their own recovery as they become more active participants in their care. Some are even choosing not to undergo suggested therapies and are returning home to put their lives in order and let disease processes take their natural course, even until death. As for leukemia, more supportive measures such as blood component therapy and evaluative work-ups are being offered on an outpatient basis. Patients are learning self-care measures to counteract or minimize side effects to chemotherapy or radiation therapy. Thus, overwhelming infection is of less risk and hospitalization is shortened. Infection, especially from Staphylococcus aureus, still remains a major cause of death of patients with leukemia. However, one must consider how prevalent this organism is in the hospital environment. Home care management is improving; care can be as comprehensive as one might need or receive in the hospital setting.

The effects of zinc deficiency on turnover of cadmium-metallothionein in rat liver.

The object of this experiment was to determine the effects of Zn deficiency on the turnover of Cd-induced metallothionein (MT) in rat liver. Male rats were fed a purified Zn-deficient or Zn-adequate diet. After 13 days, the rats were given three daily injections of Cd2+ totaling 1.5 or 3.0 (Zn-deficient) and 3.0 or 6.0 (Zn-adequate) mg Cd/kg body weight. The MT was labeled by injecting the rats with [35S]cystine 2 hours after the final Cd injection. One, 3 or 5 days after labeling, the rats were killed, and their livers were assayed for MT 35S and metal content. The metal composition of MT (mole %) was 41-42% Cd, 51-54% Zn and 4-7% Cu in the Zn-adequate groups and 64% Cd, 27-31% Zn and 6-9% Cu in the Zn-deficient groups. The half-lives of Cd-induced MT in the Zn-deficient rats were 2.6 days (1.5 mg Cd/kg) and 2.8 days (3.0 mg Cd/kg). In the Zn-adequate rats, the half-lives were 3.6 days (3.0 mg Cd/kg) and 3.1 days (6.0 mg Cd/kg). The half-lives of general, soluble hepatic proteins were 4.1 to 4.3 days in all groups. Despite the stabilizing effect of the higher Cd content, the half-life of hepatic MT in the Zn-deficient rats was significantly shorter than in the Zn-adequate rats. These results indicate that hepatic MT degradation is faster in Zn-deficient animals.

Cognitive mapping and elderly adults: verbal and location memory for urban landmarks.

This study provides a real-world memory task that extends the ecological validity of previous research on aging and spatial memory. Elderly individuals were found to have less accurate verbal recall of urban landmarks and location memory for landmarks than younger adults. In addition to these quantitative differences in environmental cognition, qualitative aspects of the data were explored. In order to explain the poorer memory performance of elderly adults, participants' use of a geographically based, organizational mnemonic was examined. Furthermore, discriminant analysis revealed that the elderly relied more than younger adults on certain building attributes for memory of urban landmarks. These building attributes include: high public use, high symbolic significance, naturalness of surroundings, direct access to streets, and unique architectural style.

Management of anorectal horseshoe abscess and fistula.

Over a 10-year period 69 patients were treated consecutively for posterior and anterior horseshoe abscesses and fistulas. Fifty-nine patients had posterior and ten had anterior abscesses or fistulas. There were 52 patients with acute abscess. Treatment consisted of incision and drainage, incision and drainage with primary fistulotomy, incision and drainage with primary fistulotomy and counter-drainage, and incision and drainage with insertion of seton. Seventeen patients with chronic fistulas were treated by primary fistulotomy with curettage, or incision and drainage with insertion of seton. Patients were followed from three months to ten years with a mean follow-up of three years. No incidences of incontinence were reported in this series. The overall rate of recurrence was 18 percent, and included only patients with posterior abscesses and fistulas. Recurrence was related to the failure to maintain prolonged drainage in the midline after primary fistulotomy. The use of seton for delayed fistulotomy appears to promote wound drainage and precludes premature wound closure. More liberal use of the seton in the treatment of horseshoe abscesses and fistulas is advocated.

O6-methylguanine-DNA methyltransferase in normal and malignant tissue of the breast.

An important component of high-dose chemotherapy/autologous bone marrow support regimens for adjuvant treatment of breast cancer is carmustine. Preclinical studies have shown that the level of the DNA repair protein O6-methylguanine-DNA methyltransferase is correlated with the resistance of cultured human tumor cells to this drug, but little is known about transferase levels of breast tissue in vivo. We measured the DNA repair activity in 80 tissue samples from 65 patients, including normal, abnormal, benign, and malignant specimens. Wide interindividual variations was observed and average transferase levels were similar in normal and benign tissue. However, transferase levels were significantly elevated in stage I-IV disease. In addition, the frequency of samples with no detectable transferase was greatly reduced in this malignant group, and transferase was positively correlated with the presence of positive nodes, a marker for disease progression. In contrast, transferase levels were not correlated with age or estrogen receptor status, and the levels in normal tissue did not vary between patients with benign or malignant disease. These results suggest that this DNA repair activity may be increased in breast cancer relative to normal tissue and encourage further study of the predictive value of transferase measurements in high-dose chemotherapy/autologous bone marrow transplant for breast cancer.