Maternal aerobic exercise: newborn effects.

Maternal aerobic exercise during pregnancy may affect the experience of labor for the mother or fetus. Forty-four women who had given birth in the preceding 7 months responded to questions about their exercise habits during pregnancy. Using an exercise prescription formula, respondents were dichotomized into exercise or nonexercise groups. Maternal exercise was associated with a significant decrease in the duration of the second stage of labor (27 minutes vs 59 minutes, p = 0.04) and a reduction in the incidence of obstetric complications (8 vs 19, p = 0.058). The groups showed no significant differences in the number of weeks gestation, duration of the first or third stage of labor, birth weight, birth length, or neonatal Apgar scores at one and five minutes.

Health screening examinations: the patient's perspective.

Periodic preventive screening programs will require patient cooperation if they are to be successful. To determine the level of patient interest on a broad scale, 1,788 adult patients were surveyed in 47 family physicians' offices over a statewide area. Seventy percent said they had participated in a screening health checkup in the preceding two years. Nine percent of these patients reported discovering a previously unknown condition as a result of their recent screening examination. The majority of surveyed patients said they would agree to be screened or treated with the complete list of eight suggested procedures for men and ten procedures for women. Rates of patient acceptance of specific health maintenance recommendations ranged from a low of 54 percent for influenza immunization to a high of 91 percent for a blood pressure check. Listing typical costs did not alter the selection rates of patients with insurance coverage compared with those without it. The geriatric age group was the least willing to be screened. Seventy-two percent of patients indicated that they wanted to discuss at least one wellness topic with their physician. Overall, most patients are willing to participate in the concept of a periodic health maintenance examination as recommended to them by their physician.

Localization of a highly divergent mammalian testicular alpha tubulin that is not detectable in brain.

Sequence analysis of a mouse testicular alpha-tubulin partial cDNA, pRD alpha TT1, reveals an isotype that differs from both the somatic and the predominant testicular alpha tubulins at approximately 30% of the 212 amino acid residues determined. Although this mouse testicular cDNA retains the highly conserved sequence, Glu-Gly-Glu-Glu, found in the carboxyl termini of many alpha tubulins, the protein extends substantially beyond this sequence and does not terminate with a C-terminal tyrosine. Using rabbit antiserum prepared to a novel synthetic peptide predicted from this mouse testis alpha-tubulin cDNA, we have have detected by immunoblot and indirect immunofluorescence an antigenic epitope present in testicular alpha tubulin that is not detectable in brain alpha tubulins. We find that the antiserum specifically binds to the manchettes and meiotic spindles of the mouse testis but not with neural fibers or tubulin extracts of the adult mouse brain. These results demonstrate that at least one of the multiple alpha-tubulin isotypes of the mammalian testis is expressed and used in male germ cells but not in the brain.

Epitopes of human testis-specific lactate dehydrogenase deduced from a cDNA sequence.

The sequence and structure of human testis-specific L-lactate dehydrogenase [LDHC4, LDHX; (L)-lactate: NAD+ oxidoreductase, EC 1.1.1.27] has been derived from analysis of a complementary DNA (cDNA) clone comprising the complete protein coding region of the enzyme. From the deduced amino acid sequence, human LDHC4 is as different from rodent LDHC4 (73% homology) as it is from human LDHA4 (76% homology) and porcine LDHB4 (68% homology). Subunit homologies are consistent with the conclusion that the LDHC gene arose by at least two independent duplication events. Furthermore, the lower degree of homology between mouse and human LDHC4 and the appearance of this isozyme late in evolution suggests a higher rate of mutation in the mammalian LDHC genes than in the LDHA and -B genes. Comparison of exposed amino acid residues of discrete antigenic determinants of mouse and human LDHC4 reveals significant differences. Knowledge of the human LDHC4 sequence will help design human-specific peptides useful in the development of a contraceptive vaccine.

Cancer care in the 1980s.

Even when all available preventive strategies are strongly encouraged, the diagnosis of cancer will often be encountered in the primary care setting. Patients will look to their personal physician for advice in dealing with their illness and commonly ask, "What would you do?" Knowing the patient well, whether he or she desires to fight for every possible day of life or apparently welcomes an earlier death with freedom from life prolongation therapies, is the basis for helping the patient to choose alternatives. Informed decisions by the physician are facilitated by appropriate classification and staging of the tumor. Entrusted to the primary physician are numerous responsibilities that include team management, aiding the patient and family to cope with the illness, and maintaining a quality life with the best possible functional status. Both patient and physician must fully understand and share what is known about the cancer in order to individualize treatment with the proper level of care. Modern cancer care is highly sophisticated and changeable; to do it well requires a special interest and attention from the physician.

Symptom control in terminal illness.

Toward the goal of comfort and quality of life, symptom management is utmost in importance and requires constant reassessment of the patient. Before launching a medication program, each set of symptoms should be assessed by history, physical examination, and laboratory tests. When symptoms can be understood in the context of the disease without correctable, specific causes, the physician can carefully prescribe treatments to alleviate the misery and suffering. The most common symptoms in terminally ill cancer patients are anxiety and depression (80 to 90 per cent); pain (66 per cent); nausea, vomiting, and constipation (50 per cent); and respiratory symptoms (30 to 40 per cent). Medical attention to these discomforts will help the patient and family to cope better with the dying process.

Pain management.

Successful management of pain can be accomplished in nearly all terminally ill patients. Pain must be assessed in terms of its physical, psychological and social components. Spiritual care and control of environmental factors are just as important as drug therapies. Once the cause of the pain is identified, an individualized plan of treatment can be developed. Nondrug therapies are tried first. When drugs must be used, the pain is treated by regular dosing to prevent recurrent breakthroughs--no PRN orders are used. The pain is blocked and its memory erased so that continued, uninterrupted relief is given. Drug management should provide ease of administration to maintain patient independence, unclouded and normal affect, and minimal troublesome side effects. Anticipatory treatment of expected problems with constipation and nausea should be done. By using a reproducible pain measurement scale, titration of drugs is carried out in a stepwise fashion, increasing dosage or potency until the desired effect is achieved. With multimode therapy, no patient should have to suffer the aching/agony pain cycle of terminal illness with cancer.

Locus determining the human sperm-specific lactate dehydrogenase, LDHC, is syntenic with LDHA.

From the data presented in this report, the human LDHC gene locus is assigned to chromosome 11. Three genes determine lactate dehydrogenase (LDH) in man. LDHA and LDHB are expressed in most somatic tissues, while expression of LDHC is confined to the germinal epithelium of the testes. A human LDHC cDNA clone was used as a probe to analyze genomic DNA from rodent/human somatic cell hybrids. The pattern of bands with LDHC hybridization is easily distinguished from the pattern detected by LDHA hybridization, and the LDHC probe is specific for testis mRNA. The structural gene LDHA has been previously assigned to human chromosome 11, while LDHB maps to chromosome 12. Studies of pigeon LDH have shown tight linkage between LDHB and LDHC leading to the expectation that these genes would be syntenic in man. However, the data presented in this paper show conclusively that LDHC is syntenic with LDHA on human chromosome 11. The terminology for LDH genes LDHA, LDHB, and LDHC is equivalent to Ldh1, Ldh2, and Ldh3, respectively.

Theophylline clearance during pregnancy.

Theophylline clearance was prospectively studied in eight pregnant asthmatic patients who were receiving maintenance doses of theophylline. The study was designed to analyze theophylline clearance on three occasions during pregnancy and once postpartum. Theophylline clearance during the third trimester was significantly lower than that postpartum. Six patients had clearance measured both during pregnancy and postpartum and of these, five displayed a reduction in theophylline clearance during pregnancy that ranged between 20 and 53%. Two patients required dosage reductions due to symptoms of toxicity. These results indicate that theophylline clearance is frequently reduced during pregnancy, resulting in excessive serum levels. Patients should be observed for toxicity, and theophylline serum levels should be measured more frequently during the last half of pregnancy.

The effect of taking a sexual history on the notation of sexually related diagnoses.

Many patients have questions or concerns about sex, but few talk directly about the subject with their physician. Including a sexual history during the physician-patient encounter is one way to indicate to the patient that discussing sexual concerns is appropriate. We observed that physicians at the University of Iowa Family Practice Center were divided into two groups: those who routinely include a sexual history with a new patient and those who do not. Those physicians who claimed to routinely take a sexual history reported 33.3% of their patients had some type of sexual question, concern, or problem; those who claimed they do not include such a history reported only 9.5% had a sexual concern (P less than 0.05). Female physicians were less apt to take a sexual history than male physicians (11.8% v. 60%; P less than 0.001). We conclude that education in sexual history taking is an important part of the family practice curriculum for resident training.

Effect of a rapid diagnostic method on prescribing patterns and ordering of throat cultures for streptococcal pharyngitis.

The sensitivity and specificity of a rapid identification test for group A beta-hemolytic streptococcus and its impact on prescribing antibiotics and ordering throat cultures were evaluated in a primary care office setting. The calculated sensitivity, specificity, positive predictive value, and negative predictive value were 82 percent, 92 percent, 76 percent, and 94 percent, respectively. Throat cultures were ordered for 98 percent of patients with acute pharyngitis regardless of the method of testing available. After use of the rapid identification test within the office, a reduction was observed in physician prescribing of antibiotics before the throat culture results were known. Physicians were more likely to initiate antibiotics immediately when rapid test results for streptococcal infection were positive and provide patient education regarding symptomatic treatment when the results were negative. The rapid identification test is an acceptable alternative to the standard culture technique in the family practice office. The rapid test was apparently responsible for the observed reduction in antibiotic prescribing and should reduce unnecessary cost and antibiotic exposure in the ambulatory setting.