In vitro growth modulation by L-ascorbic acid of colony-forming cells from bone marrow of patients with myelodysplastic syndromes.

In vitro colony growth was studied on bone marrow cells from 51 patients with myelodysplastic syndromes (MDS), using a cell culture method with the unique feature of daily feeding, in an effort to gain insight into the pathophysiology of MDS and to assess the clinical utility of this cell culture assay. The colony growth pattern of MDS marrow cells is remarkably similar to that of acute myeloid leukemia but quite dissimilar from that of normal marrow, in support of a common pathophysiological mechanism for these two disorders. In particular, L-ascorbic acid (LAA) enhanced colony growth in 30% and suppressed growth in 16% of cases, a finding also similar to that in acute myeloid leukemia, indicating a unique growth requirement which may be explored for therapeutic purposes. Further, these LAA effects have prognostic value, with LAA-sensitive (both LAA-enhanced and LAA-suppressed) cases displaying shorter survivals than LAA-insensitive cases (median survival of 5 months versus 18 months; P = 0.011). This prognostic value is independent of, and more powerful than, bone marrow blasts; the median survival was 18 months for less than 5% bone marrow blasts and 8 months for greater than 5% bone marrow blasts (P = 0.044). These two risk factors can be used together to identify patients with an extremely good or an extremely poor prognosis. This study establishes the clinical usefulness of the LAA effect in MDS as a prognostic factor and provides a new lead to explore in understanding differential biochemical/molecular events and, possibly, a new therapeutic approach to the management of MDS.

Predicting weight loss success among obese clients in a hospital nutrition clinic.

A retrospective study of 63 obese patients seen in a hospital outpatient nutrition clinic was reported. The majority suffered from one or more other medical problems. The relationship of amount of and rate of weight loss to various factors was examined. The multivariate analysis revealed that either the amount or rate of weight loss was greater in the patients who were more overweight initially, white, male, young, single, older at age of onset of obesity, visited the clinic for a longer period of time but less frequently. Conversely, the amount or rate of weight loss was less in those patients receiving conjugated estrogens, oral contraceptives, propranolol, thioridazine HCl, and those who were receiving behavior modification as treatment.

Amitriptyline in migraine prophylaxis.

In a controlled trial of amitriptyline hydrochloride in migraine prophylaxis, 100 patients received placebo for a four-week baseline period and then were randomized in double-blind fashion to therapy with amitriptyline (47 subjects) or placebo (53 subjects) for another four to eight weeks. Subjects received up to four 25-mg tablets of amitriptyline hydrochloride or identical placebo per day. Comparing the first and second four-week periods for each patient, the conditions of 55.3% of amitriptyline subjects as opposed to 34.0% of placebo subjects were greater than or equal to 50% improved and the difference between amitriptyline and placebo response rates was significant (P less than .05). Nondepressed subjects with severe migraine and depressed subjects with less severe migraine responded best to amitriptyline, whereas depressed subjects with severe migraine had little headache relief. Amitritryline is an effective antimigraine agent and the antimigraine effect seems relatively independent of antidepressant activity.

Environmental risk factors in siblings with Parkinson's disease.

To investigate possible risk factors in Parkinson's disease, we conducted a case-controlled study of 19 families having two or more siblings with Parkinson's disease. Demographic data were collected, including lifetime histories of places of residence; sources of drinking water; occupations, such as farming; and exposure to herbicides and pesticides. Rural living and drinking well water, but not farming and herbicide exposure, were significantly increased in 38 parkinsonians compared with 38 normal control subjects. A comparison of parkinsonian siblings with siblings with essential tremor revealed no differences in any risk factors for the years of shared environment. These data suggest that living in a rural environment and drinking well water are risk factors for Parkinson's disease and that the total life exposure to an environmental toxin may be more important than exposure in early life.

Migraine prophylaxis. A comparison of propranolol and amitriptyline.

The comparative efficacy of propranolol and amitriptyline in the prophylaxis of migraine headache was studied in 30 patients in a double-blind, placebo-controlled, crossover design. Headache response to medication was measured monthly by compilation of headache scores derived from quantitative data recorded by patients in a daily diary; at each visit, Zung and Hamilton tests for depression and the Spielberger state test for anxiety were performed. In the absence of clinical toxicity at monthly visits, the decision to maintain the current dose or raise it was made by a computer, which compared current headache score with that of the previous month. Both drugs were superior to placebo. Neither drug was superior to the other. The effectiveness of neither drug correlated with a decrease in anxiety or depression demonstrated by psychological testing.

Platelet aggregation, stroke, and transient ischemic attack in middle-aged and elderly patients.

Platelet aggregation was studied with optical density methods in a group of 39 patients with stroke or transient ischemic attacks (TIA) and in age, sex, and race-matched controls. The patients were divided at age 60 into young stroke patients and young controls (18 pairs) and old stroke patients and old controls (21 pairs). A semiquantitative measure of the threshold of phase II of platelet aggregation and distinct of disaggregation 3 minutes after peak aggregation were used as an index of platelet aggregability. Aggregability was significantly greater in young stroke patients than in young controls. Aggregability was similar in old stroke patients and old controls. Both old stroke patients and old controls were hyperaggregable compared with young controls, indicating that aggregability rises with age. This suggests that platelet aggregability is significant risk factor for stroke but is relatively more important in the younger than in the older stroke patient.

Platelet aggregability in migraine.

Employing optical density methods, platelet aggregation in response to 1.275, 1.7, and 3.4 micrometer adenosine diphosphate was tested in 46 patients with migraine and 46 controls matched by age, sex, and race. The migraine patients demonstrated platelet hyperaggregability when compared with controls, as manifested by a lower threshold for the platelet-release reaction and increased platelet stickiness following aggregation. There was no correlation of platelet hyperaggregability with the severity of migraine or with the occurrence of migraine-associated neurologic symptoms, suggesting that platelet hyperaggregability is a concomitant feature of the migraine syndrome but not dependent on the occurrence of the actual headache. As platelet hyperaggregability may predispose to development of intravascular platelet aggregates or mural thrombi, the hyperaggregability found here may help explain the increased incidence of stroke and heart attack in migraine patients that has been reported elsewhere.

Characteristics of life headache histories in a nonclinic population.

A detailed questionnaire concerning life history of headache and its characteristics was administered to 1,809 nonmedical volunteers. Questions dealt with severity of headache, the nature of preceding and accompanying phenomena (nausea, visual scotomata, neurologic symptoms), precipitating factors, and history of other illness. For the total sample and in the 25 to 39 age group, severe or disabling headaches were significantly more frequent in women and mild headaches were significantly more common in men. Migraine characteristics were common with mild headache. An association between hypertension and severe headache was found in women, between asthma and severe headache in men.

Univariate and multivariate statistical analysis of high-grade gliomas: the relationship of radiation dose and other prognostic factors.

Univariate and multivariate statistical analyses were used to examine the relationships between duration of survival and multiple variables in the presentation and treatment of 82 patients with high-grade gliomas (16 grade 3, 66 grade 4). The median survival time of the eight patients who received less than or equal to 40 Gy to the tumor bed was 16 weeks and was 17 weeks for the three who received between 40 and 50 Gy. Patients who received 50-60 Gy had a median survival time of 62 weeks, compared to 54 weeks in patients who received 60-70 Gy. These differences in median survival time were statistically significant between the extremes (p = 0.0001), as well as between the 40-50 Gy group and the 50-60 Gy group (p = 0.02). However, no significant difference could be detected between the groups receiving 50-60 Gy versus 60-70 Gy. Univariate analysis also identified preoperative performance status, age, histologic grade, extent of surgery, and seizure history as prognostic factors. Cox multivariate analysis was performed to identify variables that were significant in independently predicting duration of survival. Although contemporary studies have shown many variables to be significant in predicting survival, our analysis found that many of them were not independent predictors. The variables which independently predicted improved duration of survival were greater total radiation dose to the tumor bed (p less than 0.0001), superior preoperative performance status (p = 0.003), and grade 3 versus grade 4 (p = 0.04). Younger age at diagnosis was marginally significant (p = 0.07). In the group of 60 patients receiving greater than 50 Gy, a discriminant analysis was also performed. The patients were divided into two groups based on apparent clusters of survival times: greater than or equal to 60 weeks versus less than 60 weeks. The only variable that was found to be predictive of membership in the cluster with longer survival was the presence of seizure activity (p = 0.02). Although univariate and multivariate analyses both showed an apparent statistically significant improvement in survival with increasing total radiation dose to the tumor bed, no additional benefit could be demonstrated for doses greater than 60 Gy.

Evaluation of group well-child care for improving burn prevention practices in the home.

The inclusion of counseling on home safety procedures has been recommended by the American Academy of Pediatrics as a routine part of well-child care. However, few, if any, data exist to give direction to the pediatrician interested in advising parents about home safety. In the present study, 58 couples were randomly assigned, prospectively, to an experimental group and a control group. Both were enrolled in a single group well-child care class that lasted 90 minutes. The control group was provided with information and discussion on nutrition, dental care, safety in the car and home, child development, child rearing, illness management, and immunizations. The experimental group received information and discussion on the same topics, and they also received specific information on burn prevention: hot water heater settings and smoke detectors. On a subsequent home visit, 65% of the couples in the experimental group had their hot water temperature measured at 54.4 degrees C (130 degrees F) or less, whereas all of the couples in the control group had hot water temperatures of more than 54.4 degrees C (130 degrees F) (a significant difference). Although only one couple in the experimental group did not have an operational smoke detector, enough of the couples in the control group had operational smoke detectors that results were not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Transmission of Toxoplasma gondii in Panama City, Panama: a five-year prospective cohort study of children, cats, rodents, birds, and soil.

A cohort of more than 500 children from Panama City, Panama was studied prospectively over five years for acquisition of antibody to Toxoplasma gondii. The direct agglutination test showed that 72 of 571 children seroconverted between one and six years of age, for a cumulative incidence of 12.6%. Children were examined by pediatricians quarterly, and illnesses that had occurred in the interval and their activities were noted on questionnaires. Thirty-eight variables were examined for their role as risk factors for seroconversion. There was a higher correlation between children's seroconversion and contact with dogs than with cats. Combinations of significant predictors without dogs explained only 67% of the seroconversions, but the same factors with dogs explained 90%. On the other hand, ingestion of raw or rare meat or eggs appeared to play no role in transmission. Cats were examined and 110 (45.6%) of 241 had Toxoplasma antibody on the first bleeding. Only two (0.5%) of 383 cat fecal specimens, when tested in mice, resulted in seroconversion. Ten (1.1%) of 924 soil samples resulted in seroconversion in mice that had been injected. Antibody to Toxoplasma was found in 52 (23.3%) of 226 rats (Rattus norvegicus) and two (0.035%) of 571 mice (Mus musculus). Two hundred sixteen birds of 16 different species were bled. Antibody to Toxoplasma was found in 13.4% of these birds, mostly in grackles, blue-gray tanagers, and doves. The rate of isolation of Toxoplasma was low: one of 23 in rats and three of 201 in birds. High relative risks (RRs) of transmission to children were predicted by contact histories with nursing dogs (RR = 5.8), weaned dogs (RR = 4.7), many flies (RR = 3.6), 6-12-month-old dogs (RR = 3.4), weaned cats (RR = 3.0), 6-12-month-old cats (RR = 2.7), nursing cats (RR = 2.5), much garbage (RR = 2.4), and many roaches (RR = 2.2). The high statistical correlation of dog contact with seroconversion in children suggests the possibility that dogs, by eating and rolling in cat feces, are instrumental in mechanically transmitting Toxoplasma infection. In addition, flies, and to a lesser extent, cockroaches, may have practically important roles in transmission.

Late hyponatremia in very-low-birth-weight infants: incidence and associated risk factors.

OBJECTIVE: To determine the incidence of late hyponatremia in very-low-birth-weight infants and to identify associated risk factors. Low serum sodium concentration in otherwise healthy premature infants beyond 2 weeks of life is referred to as the hyponatremia. DESIGN: Retrospective cohort review. SETTING/SUBJECTS: The intensive care nursery at St Luke's Hospital Perinatal Center, Kansas City, Mo. Criteria for subject selection were birth weight of 1,500 g or less; survival for more than 21 days; development of late hyponatremia or hospitalization for 42 days or more; and measurement of serum sodium concentration at least once between the 14th and 56th day of life. Of 515 infants admitted to the nursery for the 1992 calendar year, 124 had a birth weight of 1,500 g or less and survived for more than 21 days; however, 16 of these infants were discharged at 42 days of life or less, 11 did not have a serum sodium concentration measurement after the second week of life, and 1 did not have complete medical records. Thus, the final sample was 96 subjects. STATISTICAL ANALYSES: Percentages to determine incidence of late hyponatremia; t test of chi 2 test to determine differences between infants with and without late hyponatremia; multiple logistic regression to determine the strongest indicators of late hyponatremia. RESULTS: Incidence of late hyponatremia was 62.5%. Significant risk factors for late hyponatremia were birth weight of 1,000 g or less (P < .001), feedings of fortified human milk (P < .013), and occurrence of an intraventricular hemorrhage (P < .036). Fortified human milk feeding was a significant risk factor for late hyponatremia in both weight groups (ie, birth weight greater than or less than 1,000 g). CONCLUSION: Despite standard fortification, human milk may contain an insufficient quantity of sodium to met the needs of very-low-birth-weight infants.

Classification of essential tremor.

Classification of essential tremor was attempted using tremor frequency; tremor duration; family history of tremor; responsiveness to alcohol, propranolol, and primidone; muscle contraction pattern; and long-latency reflexes. Sixty-one patients were evaluated. The majority of patients had a tremor frequency less than 7.0 Hz, a positive family history, and a positive response to alcohol. Approximately 46% of patients had a beneficial response with propranolol and 71% with primidone. Tremor frequency was inversely correlated with age and directly correlated with an antagonist pattern of muscle contraction. Enhanced long-latency reflexes were not found. Other characteristics of essential tremor were not significantly correlated. It is concluded that essential tremor can not be classified into subtypes.

Iliac crest bone graft harvest donor site morbidity. A statistical evaluation.

STUDY DESIGN: This study analyzed the cause, rate, and risk factors of iliac crest bone graft donor site morbidity. OBJECTIVES: All complications or problems, no matter how small, were sought to develop strategies of prevention. SUMMARY OF BACKGROUND DATA: A wide range of major, 0.76% (Keller et al) to 25% (Summers et al) and minor complications, 9.4% (Keller et al) to 24% (Summers et al) has been reported. METHODS: A consecutive series of 261 patients, whose bone graft harvest was done by one surgeon, was studied by chart review and a mail survey that was not conducted by the operating surgeon. The survey presented specific open-ended questions designed to uncover any complication/problem, no matter how small. Complications then were categorized as major or minor and subcategorized as acute or chronic. Statistical analysis was done using chi-squared and multiple logistical regression. RESULTS: None of the 261 patients had a severe perioperative complication--e.g., superior gluteal artery injury, sciatic nerve injury, or deep wound infection. None of the 225 patients with long term follow-up (average, 66 months; range, 32-105 months) had a severe late complication--e.g., donor site herniation, meralgia paresthetica, pelvic instability, or fracture. Of the 180 patients meeting the qualifications for statistical analysis, major complications occurred in 18 (10%), only three of which affected function (pain). Minor complications occurred in 70 (39%). CONCLUSIONS: The results indicated that severe complications from iliac crest bone graft harvest can be avoided and major complications affecting functioning are uncommon, but minor complications are common. The findings suggest that procedural refinements of limiting subcutaneous dissection and providing layered tension-free incision closure may improve results.

Health problems in Galena, Kansas: a heavy metal mining Superfund site.

Health problems at a heavy metal mining Superfund site were surveyed using prevalence information from 1980-85. Current environmental exposures include lead and cadmium in drinking water, mine wastes, and surface soils. Age- and sex-specific illness rates in whites in an exposed town (Galena) were compared with similar rates in two control towns. Multivariate analyses of morbidity data examined statistically significant risk factors for relevant illness in the three towns. Mortality rates for 1980-85 for white residents of Galena and for the U.S. were compared using univariate analysis. Among residents of the three towns who had lived there at least 5 years prior to 1980, there was either a statistically significant or borderline excess reported prevalence in Galena of chronic kidney disease (females aged greater than or equal to 65), heart disease (females aged greater than or equal to 45), skin cancer (males aged 45-64), and anemia (females aged 45-64). Multivariate analyses revealed statistically significant associations of stroke, chronic kidney disease, hypertension, heart disease, skin cancer, and anemia with variables related to Galena exposure. Personal physicians were contacted to confirm the information provided by the subjects; validity was good for all reported illnesses except chronic kidney disease. A statistically significant excess of deaths from hypertensive disease (females aged greater than or equal to 65), ischemic heart disease (males and females aged greater than or equal to 65), and stroke (females aged greater than or equal to 65) was found in residents of Galena City. This study confirms that environmental agents in Galena are associated with, and may have contributed to, the causation of several chronic diseases in residents of this community. Further studies are recommended.

Identifying the needs of home caregivers of patients with cancer.

Increasing numbers of patients with cancer are being cared for by home caregivers. The primary purpose of this methodologic, correlational study was to identify, categorize, and assess the importance of needs expressed by 492 home caregivers and to determine how well these needs were satisfied. Caregivers surveyed were selected from the records of two nonprofit community cancer agencies and two hospital outpatient oncology clinics in the Midwest. These individuals were identified by at-home patients with cancer as unpaid people who helped with physical care or coping with the disease process. Caregiver characteristics and patient activity were examined to determine their relationships to caregiver needs, and needs were examined over time. The 90-item Home Caregiver Need Survey used in this study was developed by the author in 1989 and demonstrated internal consistency, reliability, and construct validity. Using factor analysis, six need categories were identified: psychological, informational, patient care, personal, spiritual, and household. Caregivers' greatest needs were informational and psychological. Significant correlations between certain caregiver characteristics and caregiver needs and between caregiver needs and patients' activity levels were found. Both the importance and satisfying of needs changed over time. Findings indicate the urgent need for nurses, who usually provide support for caregivers, to establish specific programs and services to meet the identified and unmet informational and psychological needs of caregivers of at-home patients with cancer. Frequent reassessment of caregiver needs seems to be indicated.

High-risk children referred to an early-intervention developmental program.

Early-intervention programs for infants with developmental disabilities or with high-risk factors for such problems were first established in the United States more than 20 years ago. The benefits of such programs are generally recognized. This study describes the presenting problems of 698 children referred to an early-intervention program over a 15-year period (1975-1989). Medical condition groups rather than specific diagnoses are considered. The developmental progress of 464 children who attended the program for at least 6 months was determined by comparing their admission and discharge developmental quotients (DQ). Admission trends over time are noted and the value of intervention programs for young children with disabilities is discussed.

Childhood cancer survivors: attained adult heights. Compared with sibling controls.

As part of a large collaborative study, the authors administered a pretested questionnaire to 62 childhood and adolescent cancer survivors and 62 same-sex sibling controls. The authors requested information regarding attained adult height on the questionnaire. Mean adult height of survivors (172.2 cm) was less than that of controls (174.1 cm), at a borderline significant difference of p = 0.0757. Multivariate analysis examined four potential, independent variables as possible predictors of this difference. The presence of brain tumor (vs. nonbrain tumor) (p less than .0001) and diagnosis at an early age (less than or equal to 8 years vs. 9-15 years) (p = .05) were factors significantly related to the differential; sex of patient and type of therapy were not. Our findings thus identify malignancy site and age at diagnosis as important predictors of adult height in childhood and adolescent cancer survivors.

Efficacy and efficiency: self-designed versus instructor-designed study tools.

During the course of their education, occupational therapy students learn to administer complex structured assessments. For easier administration of these assessments, students design note cards, which then replace cumbersome test manuals during administration. This study considered whether students could learn test administration with equal efficiency and efficacy if given test administration note cards rather than having to design their own. The results showed that the subjects using instructor-designed cards earned written test and practical examination scores similar to those of the subjects using self-designed cards. The subjects using instructor-designed cards spent significantly less (p = .003) total time in study than did the subjects using self-designed cards. The difference in time between the two groups was attributable to the time spent designing note cards. Therefore, distribution of instructor-designed note cards appears to offer equally effective and significantly more efficient learning when compared with that produced when students design their own cards. The differences in efficacy and efficiency were similar for students of different learning styles (as classified by Witkin's field-dependence/field-independence continuum) [corrected].

Barriers to research in allied health.

In 1980, the National Commission on Allied Health Education recommended a needs assessment be done to determine the barriers to research in allied health faculty. This study presents the results of a survey of such faculty members conducted by selecting a random national sample of faculty members in 16 schools of allied health, and soliciting the anonymously reported perceived research barriers from the faculty members. Research barriers in eight major categories were identified. Categories with the largest number of faculty members reporting that the needs were major barriers to research activity were: additional personnel, research philosophy, funds, in-service education, information, and space. Results emphasized the fact that allied health faculty have time already heavily committed to clinical and teaching responsibilities, and that more time for research was desired than was presently available.