A technique for spot application of fibrin glue during open heart operations.

Several techniques have been described for preparing and applying fibrin glue to control surgical bleeding. However, these methods tend to be cumbersome, expensive, or messy. Furthermore, commercial kits have not been approved by the Food and Drug Administration because of the potential risk of hepatitis contamination. Therefore, we have devised a modified, simpler technique that enables the precise, pinpoint application of fibrin glue. The risk of hepatitis transmission is substantially reduced by using cryoprecipitate plasma instead of fibrinogen from pooled donors. This technique is especially well suited for anastomoses of small vessels or for sealing suture holes in nonporous grafts.

The effects of auranofin and parenteral gold in the treatment of rheumatoid arthritis: an X-ray analysis.

X-rays from patients in comparative studies of auranofin and parenteral gold were obtained before and during treatment, and analysed using a modification of the method of Larsen. One hundred and nineteen auranofin-treated and 113 parenteral gold-treated patients contributed data, which were analysed for changes from 0-6 months, 0-12 months and from 0-6 and 12 months. Progression of erosive processes and of joint grade occurred with both treatments, but the proportion of patients with progression in the first six months was greater with auranofin treatment. However, there was evidence that both treatments produced slowing of the erosive process during the second six months of treatment.

A flexible system for combined retrograde and antegrade delivery of blood or crystalloid cardioplegic solution.

A flexible but simple cardioplegic delivery system has been designed that offers the advantages of alternating antegrade and retrograde delivery or blood and crystalloid (Plegisol¿ solution) cardioplegia to optimize myocardial preservation. Initial antegrade delivery of crystalloid cardioplegic solution achieves rapid cardiac arrest while subsequent retrograde delivery with blood cardioplegia improves myocardial protection due to uniform distribution of the solution. Occasionally, temporary transferral from blood to crystalloid is indicated to clarify the surgical field. This system is designed to allow the repeated rapid switching from crystalloid to blood cardioplegia or vice versa using the antegrade or retrograde routes.

Left ventricular assistance with the centrifugal pump: management of the patient with stunned myocardium.

Prompt left ventricular assistance by the centrifugal pump enables the survival of many patients with postoperative low cardiac output who cannot be weaned from cardiopulmonary bypass with the aid of balloon counterpulsation and inotropic agents. Successful weaning from the centrifugal pump, however, depends on the careful selection of appropriate candidates as well as the strict control of pump flow, oncotic pressure, coagulopathy, blood pressure, and systemic afterload. The installation of a hemoconcentration device into the pump line helps control hemodilution and maintain adequate oncotic pressure. The management of a patient who was totally dependent upon left ventricular assistance is described.

Direction of conjugative transfer of IncI1 plasmid ColIb-P9.

The origin-of-transfer region of ColIb-P9 was inserted into a lambda prophage to give a bacterial chromosome mobilizable by the parental conjugative plasmid. The polarity of mobilization of chromosomal genes indicated that ColIb-P9 transfer is unidirectional, such that the transfer genes adjacent to oriT enter the recipient cell last.

Breast and cervical cancer screening among women with physical disabilities.

OBJECTIVE: This article reports findings from the National Study of Women with Physical Disabilities about rates of screening for breast and cervical cancer and factors associated with regular screening in a large sample of women with a variety of physical disabilities and a comparison group of women without disabilities. DESIGN: Case-comparison study using written survey. Data were analyzed using measures of central tendency, chi 2 analysis, logistic regression, and risk using odds ratios. SETTING: General community. PARTICIPANTS: A total of 843 women, 450 with disabilities and 393 of their able-bodied friends, aged 18 to 65, who completed the written questionnaire. The most common primary disability type was spinal cord injury (26%), followed by polio (18%), neuromuscular disorders (12%), cerebral palsy (10%), multiple sclerosis (10%), and joint and connective tissue disorders (8%). Twenty-two percent had severe functional limitations, 52% had moderate disabilities, and 26% had mild disabilities. MAIN OUTCOME MEASURES: Outcomes were measured in terms of frequency of pelvic exams and mammograms. RESULTS: Women with disabilities tend to be less likely than women without disabilities to receive pelvic exams on a regular basis, and women with more severe functional limitations are significantly less likely to do so. No significant difference was found between women with and without disabilities, regardless of severity of functional limitation, in receiving mammograms within the past 2 years. Perceived control emerged as a significant enhancement factor for mammograms and marginally for pelvic exams. Severity of disability was a significant risk factor for noncompliance with recommended pelvic exams, but not mammograms. Race was a significant risk factor for not receiving pelvic exams, but not mammograms. Household income and age did not reach significance as risk factors in either analysis. CONCLUSIONS: Women with physical disabilities are at a higher risk for delayed diagnosis of breast and cervical cancer, primarily for reasons of environmental, attitudinal, and information barriers. Future research should focus on the subpopulations that were not surveyed adequately in this study, women with disabilities who have low levels of education or income, or who are of minority status.

Prehospital correlates of sleep in patients hospitalized with cardiac disease.

The purpose of this study was to examine relationships among selected endogenous factors and sleep patterns during hospitalization in patients with cardiac disease. Participants included 33 male and female patients with myocardial infarction and unstable angina. Wrist actigraph recordings and a computerized sleep algorithm demonstrated that the participants slept for a mean of 424.55 min (SD = 114.52), had a mean sleep efficiency of 77.30% (SD = 15.80), and experienced from 5 to 32 awakenings each night (M = 13.94, SD = 6.29). The mean duration of nighttime awakenings was 9.24 min (SD = 5.60). Self-reports of sleep efficiency, sleep supplementation, and sleep disturbance, using the Verran and Snyder-Halpern (1990) sleep scale, were better than normative data reported for hospitalized patients. The combination of age, gender, New York Heart Association Functional Classification scores (NYHA Criteria Committee, 1964), and prehospitalization sleep loss explained 29% of the variance in objectively measured sleep efficiency and 46% of the variance in duration of nighttime awakenings. These findings suggest the importance of prehospitalization variable as predictors of sleep patterns in hospitalized cardiac patients and provide baseline data for future study.

Anticonvulsant drugs and cancer. A cohort study in patients with severe epilepsy.

Over 2000 epileptic patients admitted to the Chalfont Centre for Epilepsy between 1931 and 1971 and taking anticonvulsants were followed up to the end of 1977. Mortality between 1951 and 1977 was greatly in excess of that in the general population of England and Wales in that period allowing for age and sex. Some of the excess was directly attributable to epilepsy, but there were also more deaths from suicide and circulatory, respiratory, and malignant disease than would be expected. Apart from the brain and central nervous system, no particular site had a significant excess of tumours. In particular, there were no liver tumours (and only one gallbladder carcinoma). This makes it unlikely that the liver tumours produced on feeding phenobarbitone to mice are indicators of major human risk.

Genetic factors in leprosy: a study of children in Uganda.

A group of 20 990 children in Uganda was examined for leprosy over a period of 8 years. There was no evidence that the incidence of leprosy varied according to a child's genetic relationship to a leprosy patients, once allowance had been made for the grade of physical contact.

The ssb gene of plasmid ColIb-P9.

The IncI1 plasmid ColIb-P9 was found to carry a single-stranded DNA-binding (SSB) protein gene (ssb) that maps about 11 kilobase pairs from the origin of transfer in the region transferred early during bacterial conjugation. The cloned gene was able to suppress the UV and temperature sensitivity of an ssb-1 strain of Escherichia coli K-12. The nucleotide sequence of the ColIb ssb gene was determined, giving a predicted molecular weight of 19,110 for the SSB protein. Sequence data show that ColIb ssb is very similar to the ssb gene on plasmid F, which is also known to map in the leader region. High-level expression of ssb on ColIb required derepression of the transfer (tra) genes and the activity of the positive regulatory system controlling these genes, suggesting that the SSB protein contributes to the conjugative processing of DNA. A mutant of ColIbdrd-1 carrying a Tn903-derived insertion in ssb was constructed, but it was unaffected in the ability to generate plasmid transconjugants and it was maintained apparently stably in donor cells both following mating and during vegetative growth. Hence, no biological role of ColIb SSB protein was detected. However, unlike the parental plasmid, such ColIb ssb mutants conferred a marked Psi+ (plasmid-mediated SOS inhibition) phenotype on recA441 and recA730 strains, implying a functional relationship between SSB and Psi proteins.

BCG vaccination of children against leprosy in Uganda: final results.

A total of 19 200 children, all contacts or relatives of known leprosy patients, and all free of visible leprosy lesions, were included in a controlled trial of BCG vaccination against leprosy in Uganda between 1960 and 1964. They were followed for an average of 8 years, during which time 261 developed early leprosy lesions. A less comprehensive follow-up was carried out for a further 5 years, when 8 more cases of leprosy were identified.In the main intake, between 1960 and 1962, 16 150 tuberculin-negative or weakly tuberculin-positive (Heaf Grades O-II) children were allocated by an effectively random process to either a BCG-vaccinated or an unvaccinated control group. Both groups were seen and examined in an identical fashion for leprosy at approximately 2-year intervals, and precautions were taken to ensure unbiased assessment of new cases of leprosy. After 8 years, 41 cases of leprosy had been identified in the BCG-vaccinated group, and 201 in the control group, a percentage reduction in the BCG-vaccinated group compared with the control group of 80%. The percentage reduction was similar for those initially tuberculin-negative, and for those initially weakly positive, and did not depend upon the age at vaccination. It was also similar for both sexes, for contacts of lepromatous and contacts of non-lepromatous leprosy, for children having contact with one or more than one patient, and for differing grades of physical contact and genetic relationship with a patient. The protective effect of BCG vaccination continued over the 8-year period, although it may have fallen off slightly at the end.In a group of 1074 strongly tuberculin-positive (Heaf Grades III-IV) children followed in parallel with the other two groups a total of 16 cases of leprosy were identified. When adjusted for age, this incidence is 58% lower than that in the unvaccinated control children who were initially tuberculin-negative, indicating a protective effect against leprosy of naturally-acquired strong tuberculin sensitivity.Between 1970 and 1975, one new case of leprosy was identified in a child who had initially been strongly tuberculin-positive and had therefore not been vaccinated, one in a BCG-vaccinated child, and 6 in control children. Although the follow-up in this period was less comprehensive than that in the main part of the trial, the ascertainment of cases was unlikely to have been biased towards either vaccinated or control children. These results indicate a continuing protective effect of BCG up to 12-13 years after vaccination.

Prevalence of abuse of women with physical disabilities.

OBJECTIVE: Emotional, physical, and sexual abuse of women with physical disabilities is a problem largely unrecognized by rehabilitation service providers. This article documents the prevalence of abuse of women with physical disabilities compared to women without physical disabilities. DESIGN: Case-comparison study using written survey. Data were analyzed using chi 2 analyses and the Mann-Whitney U Wilcoxon rank sum W tests. SETTING: General community. PARTICIPANTS: A sample of 860 women, 439 with physical disabilities and 421 without physical disabilities, was compiled from women responding to a national sexuality survey. MAIN OUTCOME MEASURES: The women were asked if they had ever experienced emotional, physical, or sexual abuse. If they answered yes, they were asked to identify the perpetrator(s) of the abuse and when the abuse began and ended. RESULTS: Sixty-two percent of both groups of women had experienced some type of abuse at some point in their lives. Of women who had experienced abuse, half of each group had experienced physical or sexual abuse. Husbands or live-in partners were the most common perpetrators of emotional or physical abuse for both groups. Male strangers were the most common perpetrators of sexual abuse for both groups. Women with physical disabilities also were more likely to be abused by their attendants and by health care providers. Thirteen percent of women with physical disabilities described experiencing physical or sexual abuse in the past year. CONCLUSIONS: Women with physical disabilities appear to be at risk for emotional, physical, and sexual abuse to the same extent as women without physical disabilities. Prevalence of abuse by husbands or live-in partners in this study is similar to estimates of lifetime occurrence of domestic violence for women living in the United States. Women with physical disabilities are more at risk for abuse by attendants or health care providers. They are also more likely to experience a longer duration of abuse than women without physical disabilities.

Sexual functioning among women with physical disabilities.

OBJECTIVE: Three a priori hypotheses were tested: (1) There are significant differences in sociosexual behaviors of women with physical disabilities compared with women without disabilities; (2) the sexual functioning of women with disabilities is significantly related to age at onset of disability; (3) psychological factors explain more of the variance in the sexual functioning of women with physical disabilities than do disability, social and environmental factors. DESIGN: Case-comparison study using written survey. SETTING: General community. PARTICIPANTS: The questionnaire was mailed to 1,150 women with physical disabilities who were recruited as volunteers or through independent living centers. Each woman gave a second copy of the questionnaire to an able-bodied female friend, which comprised the comparison group. The response rate was 45%, with 475 cases and 425 comparisons eligible to participate. The most common disability type was spinal cord injury (24%), followed by polio (18%), muscular dystrophy (11%), cerebral palsy (11%), multiple sclerosis (10%), joint disorders (7%), and skeletal abnormalities (5%). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Sexual-functioning, consisting of four factors: (1) sexual desire, (2) sexual activity, (3) sexual response, (4) sexual satisfaction. RESULTS: Highly significant differences were found in level of sexual activity (p = .000001), response (p = .000009), and satisfaction (p=.000001) between women with and without disabilities. No significant differences were found between groups on sexual desire. Severity of disability was not significantly related to level of sexual activity. CONCLUSIONS: Psychological and social factors exert a strong impact on the sexual functioning of women with physical disabilities. Further investigations is needed of the effect of social environment on development of self-esteem and sexual self-image, and how these influences affect levels of sexual functioning in women with physical disabilities.

Nasoenteral feeding tube insertion via fiberoptic endoscope for enteral hyperalimentation.

Total parenteral nutrition can maintain good nutritional status in selected patients. However, it can be accompanied by serious complications. It is generally agreed that enteral alimentation is more economical and safer. Gut should be used for nutritional replenishment whenever feasible. However, large-bore nasogastric feeding tubes can cause problems. Even fine-bore nasogastric tubes can cause aspiration pneumonia in obtunded and debilitated patients. In some patients it is clearly desirable to have the tip of the feeding tube in the distal duodenum or proximal jejunum. Previously described methods for placement of nasoenteral tubes may be unsatisfactory. We describe a safe, simple, and reliable method for endoscopic insertion of fine-bore nasoenteral feeding tube. We have used this method on 15 patients without complication.

Activated eosinophils upregulate the metastasis suppressor molecule E-cadherin on prostate tumor cells.

Cell adhesion molecules (CAMs) play an important role in cancer metastasis by facilitating attachment to vascular endothelia, invasion and spread into secondary tissue sites. We have shown that activated eosinophils (EosA) inhibited the growth of prostate cancer (Pca) cells in vitro. In the present study, we examined the ability of EosA 24 hr conditioned supernatants (EosAcs) to modulate the expression of ICAM-1, VCAM-1, ELAM-1, E-cadherin and N-cadherin expression on human Pca cell lines, Du-145 and PC-3 by flow cytometry. TNF-alpha, IL-10 and IL-12 were also evaluated. ICAM-1, expressed on PC-3 and DU 145 cells, was enhanced by TNF-alpha and IL-10. ELAM-1 was present on DU 145 cells but absent on PC-3. TNF-alpha and IL-10 enhanced ELAM-1 on DU 145, but EosA 24 hr supematants failed to do so. All three cytokines, namely IL-10, IL-12 and TNF-alpha-induced ELAM-1 on PC-3 tumor cells. Although VCAM-1 was absent on DU 145 and PC-3 cells, it was expressed on DU-145 cells after exposure to EosA: tumor cell co-cultures, and was expressed on PC-3 following exposure to IL-10 and IL-12. N-cadherin and E-cadherin were both expressed on DU-145. While N-cadherin was expressed on PC-3 cells, E-cadherin was not. N-cadherin was enhanced on DU-145 and PC-3 cells following exposure to EosA co-culture and upregulated on PC-3 by IL-10 and EosA 24 hr supernatants, but decreased by IL-12. E-cadherin was up-regulated on DU 145 cells following co-culture with EosA and was induced on PC-3 by IL-10 and IL-12, but not by EosA co-culture and 24 hr supematants. In conclusion, inflammatory and non-inflammatory cytokines modulate CAM expression on Pca cells; EosA and EosA 24 hr supernatants also exerted modulatory activity of CAM expression. Most significantly, the metastasis suppressor molecule, E-cadherin was enhanced on DU 145 cells by EosA and induced on PC-3 by IL-10 and IL-12 both of which are produced by EosA. This suggests potential use of these cytokines in immunotherapeutic strategies for prostate cancer and its metastasis.

Early clinical experience with bleomycin in the United Kingdom in series of 105 patients.

The results of treating a series of 105 patients (79 with advanced squamous cell carcinoma, 21 with advanced lymphoma, and 5 with miscellaneous tumours) with bleomycin are described. The drug was usually given as a single agent. Four patients with squamous cell carcinoma showed complete regression and there was partial regression in 25. Side effects were frequent, particularly skin changes and stomatitis; death from pneumonitis occurred in one patient.