Anxiety: current practices in assessment and treatment of anxiety of burn patients.

Anxiety is an affective response commonly experienced by persons after emotional and physical trauma, as well as associated with aversive medical treatments. The scientific information related to the conceptualization, assessment, and treatment of anxiety is limited. In order to develop a pilot protocol for anxiety management, nursing directors at 64 burn centers were surveyed. At 89% of the centers, anxiety measures were not used. Most of the teams assess informally through observation of patient (n=21), dialogue with patient (n=12), or both observation and dialogue with patient (n=15). Assessors of anxiety range in breadth from nurse only to the entire burn team, including pastoral care representatives and family. The class of medication most frequently endorsed in treating anxiety is the benzodiazipine, most often lorazepam (Ativan). A number of non-pharmacologic techniques are used to manage anxiety, e.g., muscle relaxation, breathing, imagery. Consideration should be given to assessing anxiety systematically, so knowledge can be gleaned and applied to conceptualization of symptom presentation and application of treatment resources.

Inhibitory effects of ascorbic acid on growth of leukemic and lymphoma cell lines.

Vitamin C has been suggested and disputed as an anti-cancer agent. Previous in vitro studies using either primary cell cultures from cancer patients or tumor cell lines have suggested that tumor cells with different lineages may have different sensitivities to ascorbic acid. In this study we report characterization of the effects of ascorbic acid on growth of two ascorbic acid sensitive and one ascorbic acid resistant lymphocyte tumor cell lines. The cytotoxic effects of ascorbic acid on the sensitive cell lines were time and dosage dependent. Furthermore, the energy state of the ascorbic acid sensitive cells was affected by the presence of ascorbic acid before the cells became apparently non-viable, as demonstrated by 31P nuclear magnetic resonance spectroscopy. The existence of these lymphocyte cell lines with varying sensitivities to ascorbic acid may provide a useful model system for further understanding of vitamin C action on cancer cells.

Cholelithiasis associated with medroxyprogesterone acetate therapy in men.

Five out of forty-five adult men, 50 years of age or less, who had received, for at least six months, medroxyprogesterone acetate (MPA, Depo Provera) IM, 200-400 mg/week, for prevention of sex-offending or genital-mutilating behavior developed symptomatic cholelithiasis. Thirty of these men were studied with gallbladder ultrasound prospectively off MPA and at six-month intervals while taking the medication and then six months off MPA. Gallstones recovered from two patients were found to have very high cholesterol content, suggesting they were formed in cholesterol supersaturated bile. These findings are consistent with the increased incidence of gallbladder disease related to high-progesterone states and suggest that MPA may be a causative agent in cholelithiasis. The physiologic studies on gallbladder contraction and cholecystokinin release in a subset of the patients failed to provide information on a mechanism for the possible increased incidence of gallbladder disease.

Control of calcium absorption: effect of sodium chloride loading and depletion.

In six out of eight patients with normal parathyroid function and in two subjects with hypoparathyroidism, sodium chloride loading was shown to increase calcium absorption as measured by the 47Ca absorption test. Although no significant change was seen in the renal and fecal excretion of calcium, a slight decrease in total serum calcium did occur with increased sodium intake. The change in calcium absorption was not accompanied by a detectable change in calcium balance. Therefore, a compensatory change in gastrointestinal calcium secretion must have occurred. Sodium intake has an effect on calcium in the gastrointestinal tract, which is independent of parathyroid hormone. Sodium intake should be considered when results of studies of calcium metabolism are compared.