Human metapneumovirus in children with bronchiolitis or pneumonia in New Zealand.

OBJECTIVES: To confirm the presence of human metapneumovirus (hMPV) in New Zealand and establish its prevalence in selected paediatric patient groups. METHODS: Nasopharyngeal swabs were collected in two separate paediatric studies enrolling children clinically diagnosed with either bronchiolitis or pneumonia and tested for hMPV by polymerase chain reaction. RESULTS: Nucleic acid detection tests demonstrated 5.3% of paediatric bronchiolitis cases were positive for hMPV RNA and 2.7% of children admitted with pneumonia tested positive for hMPV RNA. CONCLUSIONS: The presence of hMPV in New Zealand has been confirmed in two selected paediatric patient groups, namely children diagnosed with bronchiolitis and pneumonia. These results indicate that hMPV is associated with a minority of cases of bronchiolitis or pneumonia in this patient group.

The management of small cell lung cancer in Christchurch 1979-89.

The management of 215 consecutive patients with small cell lung cancer referred to the oncology service at Christchurch Hospital, 1979-89, was reviewed. After staging, 118 patients were treated with combination chemotherapy (cyclophosphamide, vincristine and doxorubicin), with (87) or without (31) thoracic irradiation. Patients with other medical problems were treated with alternative chemotherapy (34) or irradiation alone (54). Nine received symptomatic care alone. Eighty-five (40%) had limited disease, with no extrathoracic metastases beyond supraclavicular nodes. The response rate to treatment was 66%. Median survival for the whole group was 33 weeks, 51 weeks for those with limited and 26 weeks for extensive disease. The cumulative risk of developing cerebral metastases was 40% at one year. Patients surviving 26 weeks spent one third of their time as hospital inpatients or outpatients. Twenty-two patients survive, five progression free for 4-8 years, including two who had initial surgical resection. The study supports the policy of reserving intensive staging for fit patients who appear to have limited disease and for those entered into clinical trials. Fit patients with limited disease warrant treatment with combination chemotherapy and thoracic irradiation.

Bioavailability of estradiol as a marker for breast cancer risk assessment.

The search for a hormonal marker in breast cancer has centered on estrogens and their metabolites. However, direct measurements of total amounts of these steroids have shown no convincing or consistent differences between normal women and women with breast cancer. The purpose of this study was to measure the percentages of non-protein-bound estradiol (%NPBE) and of estradiol bound to albumin (%ABE) and the levels of sex hormone-binding globulin (SHBG) both in women with breast cancer and in those free of disease. Serum was collected and analyzed within 2 weeks, using an isodialysis method. The mean %NPBE and %ABE were significantly higher in 32 women with breast cancer (1.73 and 64.0%, respectively) than in 32 matched disease-free women (1.43 and 48.6%, respectively) (P less than 0.001). No significant difference was observed in the levels of plasma albumin when the above matched groups were compared. However, plasma levels of SHBG were significantly lower in the women with breast cancer than in either the control population or matched controls. In this finding we differ from previous studies which reported no significant differences in the mean plasma levels of SHBG. In our study, the increased %NPBE and %ABE in some patients with breast cancer may be related to a lower level of plasma SHBG; other factors, too, may affect the distribution of estradiol. Our results support the hypothesis than an increase in %NPBE and %ABE or both may indicate an increased risk of breast cancer.

Obesity, non-protein-bound estradiol levels, and distribution of estradiol in the sera of breast cancer patients.

This study attempted to determine the relationship of nutritional status, menopausal status, presence of breast cancer, stage of disease, and tumor estrogen receptor levels to percent non-protein-bound estradiol (%NPBE) and percent distribution of estradiol on sex hormone-binding globulin (SHBG) and albumin in breast cancer patients and control patients. Normal-weight controls had significantly lower %NPBE compared with overweight controls and normal-weight and overweight breast cancer patients. There was a significant shift in the percent distribution of estradiol from SHBG to albumin in breast cancer patients, independent of body weight. Elevated %NPBE and abnormal percent estradiol distribution on albumin persisted after mastectomy and were unrelated to menopausal status, presence and stage of disease, and tumor estrogen receptor levels. These results show that breast cancer patients have increased exposure to unbound circulating estradiol and an increased percentage of estradiol bound to albumin, which may influence the availability of estradiol, considering its low binding affinity to albumin. Because these abnormalities persist after mastectomy, the current results may be important in developing dietary intervention protocols that correct %NPBE and abnormal estradiol distribution on binding proteins.

Economics of an aging population.

Throughout this century, as in many other countries, the proportion of the British population in the older age groups has increased. The effect this has on the economy is discussed. Topics covered include the determinants of the economic status of old people; the reasons for the choice of retirement ages; the burden of the aged on younger generations; the costs of pension schemes; the disincentive effects of pensions on savings; and poverty in old age.

A comparison of the quality of participation of community affiliates and that of universities in the Northern California Oncology Group.

The quality of participation in the performance of clinical trials of university members and community affiliates of the Northern California Oncology Group is evaluated and compared. The data, based on 738 patients on 33 protocols, were collected during a one year period, July 1, 1980--June 30, 1981. The comparisons are made on three types of criteria: accrual distribution, with respect to study phase and modality multiplicity; data quality, generally reflecting protocol adherence; and data completeness. The performance of the community affiliates was found to equal or surpass that of the university members in most measures. Therefore, it is concluded that the community affiliates are functioning as full and valuable participants in the Northern California Oncology Group.

The clinical assessment of cardiovascular emergencies.

Data are given for a 2-year study of fire department ambulance runs in Houston, Texas. Comparisons are made between those runs in which telemetry was used and those in which telemetry was not used. These data show an important relationship between the prognosis of patients who were recognized by emergency medical technicians as cardiac emergencies (and therefore received telemetry service) and those patients who were not identified as cardiac emergencies and did not receive telemetry service. Criteria used for clinical assessment and classification of emergencies are discussed. Emergency life-support systems with telemetry can have significant benefit for certain selected acute, recognizable cardiovascular emergencies, but the majority of ischemic heart disease fatalities do not appear to be deriving benefit from these systems.