Enhancement of epidermal regeneration by biosynthetic epidermal growth factor.

Epidermal regeneration depends on mitosis and migration of keratinocytes. Epidermal growth factor is known to stimulate growth of keratinocytes in vitro, thus it might be expected to promote wound healing. The results of this study show that topical application of biosynthetic human epidermal growth factor accelerates epidermal regeneration in split-thickness wounds and partial-thickness burns. The significant enhancement of epidermal regeneration suggests the potential for clinical use of epidermal growth factor for accelerating healing of burns, wounds from trauma, diabetic ulcers, skin graft donor sites, and others.

Validation of a brief mental health screening tool for common mental disorders in primary healthcare.

BACKGROUND: Integrating care for common mental disorders (CMDs) such as depression, anxiety and alcohol abuse into primary healthcare (PHC) should assist in reducing South Africa (SA)'s quadruple burden of disease. CMDs compromise treatment adherence, health behaviour change and self-management of illnesses. Appropriate identification of mental disorders in primary care can be facilitated by brief, easy-to-administer screening that promotes high specificity. OBJECTIVES: To establish the criterion-based validity of a seven-item Brief Mental Health (BMH) screening tool for assessing positive symptoms of CMDs in primary care patients. METHODS: A total of 1 214 participants were recruited from all patients aged ≥18 years visiting 10 clinics as part of routine care in the Newcastle subdistrict of Amajuba District in KwaZulu-Natal Province, SA, over a period of 2 weeks. Consenting patients provided basic biographical information prior to screening with the BMH tool. PHC nurses remained blind to this assessment. PHC nurse-initiated assessment using the Adult Primary Care (APC) guidelines was the gold standard against which the performance of the BMH tool was compared. A specificity standard of 80% was used to establish cut-points. Specificity was favoured over sensitivity to ensure that those who did not have CMD symptoms were excluded, as well as to reduce over-referrals. RESULTS: Of the participants, 72% were female. The AUD-C (alcohol abuse) performed well (area under the curve (AUC) 0.91 (95% confidence interval (CI) 0.88 - 0.95), cut-point ≥4, Cronbach alpha 0.87); PHQ-2 (depression) performed reasonably well (AUC 0.72 (95% CI 0.65 - 0.78), cut-point ≥3, alpha 0.71); and GAD-2 (anxiety) performance was acceptable (AUC 0.69 (95% CI 0.58 - 0.80), cut-point ≥3, alpha 0.62). Using the higher cut-off scores, patients who truly did not have CMD symptoms had negative predictive values (NPVs) of >90%. Overall, 26% of patients had CMD positive symptoms relative to 8% using the APC guidelines. CONCLUSIONS: Using a higher specificity index, the positive predictive value and NPV show that at higher cut-point values the BMH not only helps identify individuals with alcohol misuse, depression and anxiety symptoms but also identifies a majority of those who do not have symptoms (true negatives), thus not overburdening nurses with false positives needing assessment. Research is needed to assess whether use of such a short and valid screening tool is generalisable to other clinic contexts as well as how mental health screening should best be introduced into routine clinic functioning and practice.

Sexual assault victims: factors associated with follow-up care.

OBJECTIVE: This study was undertaken to describe patient, assault, and examination characteristics associated with compliance with follow-up in sexual assault victims. STUDY DESIGN: We conducted a retrospective cohort study of consecutive women presenting to an urban hospital after sexual assault over a 36-month period. We compared those who did and did not follow-up by using standardized history, examination, and data collection forms. RESULTS: Eight hundred twelve women met inclusion criteria; 288 (35.5%) attended follow-up. Young age (odds ratio [OR] = 2.70), assault at home (OR = 1.90), amnesia (OR = 1.80), alcohol use (OR = 1.55), genital trauma (OR = 1.55), and receipt of postexamination medications (OR = 1.87) were associated with greater follow-up; homelessness (OR = 0.30), psychiatric diagnosis (OR = 0.34), assault by an intimate partner (OR = 0.47), and cocaine use (OR = 0.29) with less. CONCLUSION: Although only 35.5% of sexual assault victims seek follow-up, we found many factors positively and negatively associated with this. These findings may inform care strategies designed to improve follow-up for women who are at risk for significant sequelae.

Low energy partial ablation of the atrioventricular node junction in the dog using a suction-ablation catheter.

A suction electrode catheter was used for low energy, partial ablation of the atrioventricular (AV) node junction in 12 dogs. In 10 dogs, partial injury of the AV node was induced. In six dogs, delivered energy was measured precisely with use of a specially designed electronic circuit. The total energy required for partial ablation was 225 +/- 91 J. The increase in PR (p less than 0.0001) and AH (p less than 0.001) intervals was proportional to the energy delivered. After ablation, the PR interval increased from 98 +/- 10 to 154 +/- 33 ms (p less than 0.004) and the AH interval from 59 +/- 8 to 102 +/- 16 ms (p less than 0.004). There was no significant change in QRS, QTc, HV or RR intervals. AH and PR intervals were significantly prolonged at 3, 7 and 14 days after ablation (p less than 0.05). Anterograde conduction was significantly altered in 10 dogs. Anterograde AV node effective refractory period increased from 157 +/- 14 to 214 +/- 45 ms (p less than 0.005). Anterograde AV node Wenckebach cycle length increased from 196 +/- 30 to 244 +/- 44 ms (p less than 0.002). Retrograde conduction was assessed in three dogs. Retrograde AV node effective refractory period increased from 156 +/- 21 to 260 ms in two dogs, with complete retrograde block in the third. These changes persisted for up to 2 weeks. Pathologic changes were limited to the region of the AV node. In four dogs adherent thrombus without pulmonary emboli was noted. Partial focal injury to the AV node is feasible in the canine model.(ABSTRACT TRUNCATED AT 250 WORDS)

Manifestations of coronary atherosclerosis in young trauma victims--an autopsy study.

OBJECTIVES: The aim of this study was to look at the prevalence of coronary atherosclerosis, its severity and site of involvement in patients < 35 years old who died from noncardiac trauma. BACKGROUND: Autopsies performed on casualties of the Korean War revealed coronary artery involvement in 77.3% of the hearts studied, and data after the Vietnam War noted the presence of atherosclerosis in 45% of casualties with severe disease in 5%, suggesting a decline in the prevalence of coronary atherosclerosis in young men. METHODS: One hundred eleven victims of noncardiac trauma (86.4% white with a mean age of 26 +/- 6 years) underwent pathologic examination of their coronary arteries to estimate the presence and severity of coronary atherosclerosis grossly, microscopically and through computerized planimetry. Identified segments of the coronary arteries were sectioned at 3-mm intervals, stained with special stains and after microscopic examination transferred to videotape and digitized to allow estimation of the percent compromise in the lumen area by atherosclerotic plaque. RESULTS: Signs of coronary atherosclerosis were seen in 78.3% of the total study group, with > 50% narrowing in 20.7% and > 75% narrowing in 9%. No demographic or anatomic features separated the groups with less or more severe involvement of their coronary arteries. Proximal involvement was more common except in the right coronary artery, which was as frequently involved distally. CONCLUSIONS: The overall prevalence of coronary atherosclerosis in a young, predominantly male study group was comparable with that noted after the Korean War. Left main or significant two- and three-vessel involvement was noted in 20% of the group studied and emphasizes the need for aggressive risk factor modification in this group.

Lithium Information Center. One model of a computer-based psychiatric information service.

The Lithium Information Center has been functioning as a specialized psychiatric information service for nearly ten years. Over the years, the center has disseminated information about the medical uses of lithium to psychiatrists and other physicians, to patients, to the family and friends of patients, and to a host of other individuals and organizations including pharmacists, lawyers, nurses, social workers, mental health centers, clinics, and support groups. To encourage the development of similar psychiatric information services, we outline the center's methods of acquiring, organizing, and disseminating lithium information.

The expression of human chorionic gonadotropin/human luteinizing hormone receptors in human gestational trophoblastic neoplasms.

Normal human placental trophoblasts have recently been shown to contain receptors for hCG/hLH. The present studies investigated the expression of these receptors in hyperplastic and anaplastic trophoblasts in gestational trophoblastic neoplasms. The results demonstrated that both hydatidiform moles and choriocarcinomas contained receptor messenger RNA (mRNA) and receptor protein. A variety of nontrophoblast tumors, on the other hand, contained neither receptor mRNA nor receptor protein. Choriocarcinomas contained more receptor mRNA and receptor protein than hydatidiform moles which in turn contained more than normal human placenta. Midluteal phase human corpus luteum contained more receptor mRNA than normal human placenta and about the same as choriocarcinomas. The hyperplastic and anaplastic trophoblasts in hydatidiform moles and choriocarcinomas contained more receptor immunostaining than the normal trophoblasts in the same tissue or those from normal placentas from about the same gestational age. The receptor immunostaining increased as the degree of trophoblast hyperplasia increased in hydatidiform moles. Anaplastic trophoblasts of choriocarcinomas contained a similar amount of receptor immunostaining as severely hyperplastic trophoblasts of hydatidiform moles. Invading anaplastic trophoblasts of choriocarcinoma contained greater amount of receptor immunostaining than the surrounding endometrial stromal and myometrial smooth muscle cells. In summary, this is the first study to our knowledge demonstrating the expression of hCG/hLH receptor gene in gestational trophoblastic neoplasms. The increased receptor expression in these neoplasms suggests that hCG, via its receptors, could play a fundamental and previously unsuspected autocrine role in the regulation of trophoblast transformation, growth, invasion, and high hCG secretion.

The Lithium Index: an innovative approach to consultation by computer.

The Lithium Index, a computer consultation program, was developed at the Lithium Information Center to quickly provide up-to-date information about lithium and its side effects. Information is contained in brief summaries that are compiled from the literature, organized by clinical topic, and written and retrieved by means of an interactive computer program. Computer-stored texts are easily updated to incorporate new information. The authors present an example that deals with the use of lithium during pregnancy, the most frequently requested topic.

Tri- and tetrapeptide analogues of kinins as potential renal vasodilators.

Tri- and tetrapeptide analogues were synthesized and evaluated as renal vasodilators. These peptides were prepared by standard coupling reactions, which also provided good yields with hindered alpha-methyl amino acid derivatives. Preliminary evidence of renal vasodilator activity was determined in anesthetized dogs by measuring the effects on renal blood flow and calculating the accompanying changes in renal vascular resistance. The most potent compounds contained, in their basic structure, the L-prolyl-DL-alpha-methylphenylalanyl-L-arginine and L-prolyl-DL-alpha-methylphenylalanylglycyl-L-proline arrays. Substitution on the N-terminal proline with 4-phenylbutyryl and 4-(4-hydroxyphenyl)butyryl side chains produced enhanced renal vasodilator activity and, in certain cases, selectivity for the renal vasculature.

Effect of human IgG antiphospholipid antibodies on an in vivo thrombosis model in mice.

High levels of IgG antiphospholipid antibodies (aPL) have been associated with clinical thrombosis. It is uncertain however whether these antibodies play a direct role in thrombosis or are merely epiphenomena. To investigate whether antiphospholipid antibodies might play a role in thrombosis, we utilized a novel mouse model in which the dynamics of in vivo thrombosis can be studied. CD1 mice (26-30 g) were passively immunized with 25 mg of human IgG from a patient with the Antiphospholipid Syndrome (IgG-APS) (n = 17), IgG from normal pooled sera (IgG-NHS) (n = 9), or saline solution (n = 12), followed by 40 mg of the same preparations at 48 h. At 72 h, levels of human aPL antibodies, detected using the anticardiolipin ELISA test (aCL ELISA test), in mice immunized with IgG-APS, were 50-100 GPL units. Each animal was anesthetized, femoral vein minimally mobilized and subjected to a standardized "pinch" injury to induce thrombosis. The vessel was transilluminated using acrylic optical fibers connected to a light source, and clot formation and dissolution were visualized by a standard surgical microscope equipped with a video camera, video recorder, and computer assisted analysis system. Results showed that average clot size was significantly larger in mice immunized with IgG-APS compared to those treated with saline (p < 0.037). In addition, the thrombus persisted longer in a significantly higher number of mice immunized with IgG-APS (10/17) compared to mice immunized with IgG-NHS (1/9) or saline (2/12) (p < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Tear lithium concentration: a measurement of dubious clinical value.

A mean tear/serum lithium ratio of 0.77 +/- 0.06 was found in 13 volunteers who were given lithium carbonate for 7 days. This finding differs considerably from those of another study, which reported tear and plasma lithium levels to be quite similar. It is suggested that measurement of tear lithium concentration has no clinical utility and that further research along these lines should be discouraged.

Lithium Information Center: The Lithium Library revisited.

The Lithium Information Center's experience over the past 7 years is discussed. The center is a computer-based reference service which specializes in dissemination of information about the medical uses of lithium. At the heart of the center is the Lithium Library, a bibliographic retrieval system containing references to the lithium literature. More than 5,000 requests for literature searches and patient information have been answered by Lithium Library staff members since 1977. The center has recently expanded its services, creating the Lithium Index and Lithium Consultation, computerized programs that provide immediate answers to specific questions about lithium. The center's services are directed to patient care, lithium research, and medical and patient education. Because of topical specialization and use of computers, the Lithium Information Center has been able to provide more immediate, comprehensive, relevant, integrated, and up-to-date information than other bibliographic services.

Clomiphene citrate and neural tube defects: a pooled analysis of controlled epidemiologic studies and recommendations for future studies.

OBJECTIVE: To estimate the degree to which neural tube defects (NTDs) are associated with periconceptional clomiphene citrate (CC) exposure in controlled epidemiologic studies, to investigate the consistency of study findings with respect to this association, and to identify key problems that future studies should address. DESIGN: Pooled analysis of 10 epidemiologic studies. SETTINGS: Hospitals and clinics. PATIENTS: Women undergoing treatment for infertility. INTERVENTIONS: Oral administration of CC. MAIN OUTCOME MEASURE: Prevalence ratio for NTDs. RESULTS: Ten controlled epidemiologic studies were identified that supplied sufficient data on CC and NTDs for inclusion. The estimated ratio of NTD prevalence among CC-exposed versus unexposed pregnancies ranged from 0.55 to 5.73 among the studies, but the variation was compatible with random fluctuation. The estimated summary prevalence ratio was 1.08, with 95% confidence limits of 0.76 and 1.51. CONCLUSION: This analysis indicates that an elevation in NTD risk due to CC cannot be ruled out, but any such elevation seems likely to be less than twofold, and there may be no elevation at all. Future studies should be designed to avoid several methodological problems not addressed in studies to date.

Comparison of disposition values obtained by two assay methods for quinidine gluconate in patients with ventricular tachycardia.

Eight patients with previously untreated ventricular tachycardia, age 48.54 +/- 28.02 years (mean +/- SD), were enrolled in a protocol evaluating the disposition of quinidine gluconate as determined by two assay methods. Patients received two infusions of 5 mg/kg over 30 minutes separated by 20-30 (24.9 +/- 4.0) minutes of electrophysiologic testing. Blood samples were obtained at 0.17 hours and just prior to the second infusion, and then at 0.17, 0.25, 0.33, 1.0, 6.0, 12.0, and 24.0 hours after the second infusion. Paired serum samples were assayed for quinidine concentrations by fluorescence polarization immunoassay and high-performance liquid chromatography. The two assays compared well, with a linear regression equation of Y = 0.927X + 0.247 with a correlation coefficient of 0.985. With the exception of the beta elimination rate constant and beta distribution volume, t test comparison of disposition values demonstrated no significant difference. Differences in the estimates of the beta elimination rate constant reflected differences in the two methods and indicated that even though both assays were comparable, subtle differences in specificity could be reflected in significant differences in this variable.

Does the use of erythropoietin in hemodialysis patients increase dialysis graft thrombosis rates?

Erythropoietin (EPO) is highly efficacious in the treatment of the anemia of chronic renal failure. Evidence for a reported serious side effect, increased dialysis graft thrombosis, is equivocal. Sixty-four hemodialysis patients utilizing polytetrafluoroethylene (PTFE) grafts were treated with EPO. The patients served as their own historical controls. There were 1.188 thrombectomies and 0.222 mechanical problems per 1,000 patient-days prior to the initiation of EPO treatment. With EPO, the values were 0.656 and 0.222, respectively. Patients were separated into low-, medium-, and high-dose EPO groups and analyzed within groups for the effect of EPO and between groups for a dose-dependent response. According to an analysis of variance procedure, there was no statistically significant differences between the groups, which suggests that EPO is not thrombogenic to dialysis grafts.

[Prostate massage with unwanted consequences. Case report]. / Folgenschwere Prostatamassage. Fallbericht.

We report a case in which a regular prostate massage (chronic prostatitis) turned into a life-threatening event. After the prostate massage, an enormous periprostatic hemorrhage developed. During hospitalization the patient developed an embolic insult to the lungs. To our knowledge no ther cases have been published. This report shows the potentially serious consequences, and we conclude that any pain after prostate massage needs further diagnostic steps (ultrasound, CT scan).

Familial cardiac amyloidosis. Diagnosis by immunocytochemistry.

Familial cardiac amyloidosis is a rare disorder that is difficult to diagnose. There is no specific therapy for this disease, but it is important to distinguish the cardiac and gastrointestinal symptoms of this disease from those of other treatable causes. We have treated a patient with this disorder who presented with cardiac and gastrointestinal symptoms. The diagnosis of amyloidosis was suspected on rectal biopsy and was confirmed by immunocytochemistry and immunoalkaline phosphatase technique. Pre-albumin was demonstrated in the lesion. We concluded that when familial amyloidosis is suspected, a biopsy from the suspected organ system is helpful for the diagnosis. The detection of pre-albumin by immunocytochemistry can elucidate the diagnosis of familial amyloidosis.

Retrospective analysis of patients with primary fallopian tube carcinoma treated at the University of Louisville.

Medical records of patients diagnosed with primary fallopian tube carcinoma between 1979 and 1989 were reviewed. Twenty-six patients were eligible; 8 patients were excluded after pathologic review, leaving 18 patients included in the study for this analysis. The median and mean age were 61 and 59 years, respectively, with a range of 39-80 years. There were three Stage I, five Stage II, seven Stage III, and three Stage IV patients. The most common presenting symptoms were abdominal/pelvic pain, abdominal distension, and vaginal discharge/bleeding. The primary site of the lesion was determined to be the right tube in 44% of the cases, the left tube in 39% of the patients, bilateral lesions in 11% of the patients, and indeterminate in 6%. Histologic grade was poorly differentiated (Grade III) in 13 patients, moderately differentiated (Grade II) in 4 patients, and well differentiated (Grade I) in one. No patient was correctly diagnosed preoperatively. Survival at 5 years of the entire group was 35% with a 3 year minimum followup. Corresponding disease free survival was 30%. Mean and median survival times were 74 and 37 months, respectively. The range of survival times was from 1 to 120 months. All Stage I patients, 80% (4/5) of Stage II, and 29% (2/7) of Stage III patients are alive without disease. None (0/3) of the Stage IV patients are alive. Treatment regimens consisted of intraperitoneal P-32, external beam radiotherapy, and/or chemotherapy. Radiotherapy was associated with a low incidence of treatment-related complications, the majority being gastrointestinal related. There was one chemotherapy-related death. These patients and their treatment outcomes add to the data base of numerous previous reports on fallopian tube carcinoma. Stage I and II patients fared excellently with primary surgical and adjuvant therapy. While the prognosis of Stage III and IV patients is much worse, significant levels of long term survival can be achieved with aggressive treatment.

Wrist arthrodesis as a salvage procedure for failed implant arthroplasty.

Salvage of failed total wrist arthroplasty by arthrodesis may be difficult because of bone loss and poor quality of bone and soft tissues. We examined the outcomes of wrist arthrodesis for failed total wrist arthroplasty in a retrospective study of 21 wrists in 17 patients. Clinical data, radiographs, patient-reported outcomes and DASH questionnaires were used. Thirteen women and four men had undergone total wrist arthroplasty at an average age of 55 years. The mode of failure was aseptic loosening in 13 wrists. The average time from the index arthroplasty to wrist arthrodesis was 7.6 years. Autograft and/or allograft bone graft was used in all of the wrists. Arthrodesis was achieved in 11 wrists and ten had a nonunion. Six arthrodeses underwent eight revisions for nonunion, with two achieving union. The mean DASH score was 29 in wrists that fused and 36 in those that did not fuse. Pain scores averaged 2.1 in the wrists that fused and 3.3 in the nonunion group. Most patients had clinical improvement.