The lack of initiating and/or promoting activity of sodium malondialdehyde on SENCAR mouse skin.

Malondialdehyde (MDA), a lipid peroxidation product, has been implicated in carcinogenesis, in part for its reported mutagenic activity. It was of interest therefore, to determine its activity as either a complete carcinogen, a tumor initiator, or a tumor promoter. Using the SENCAR mouse skin model, pure sodium MDA (NaMDA) was found to lack activity in any of these categories. Furthermore, NaMDA was determined to be negative in the Chinese hamster V-79 metabolic cooperation assay for promoters.

Paraplegia and quadriplegia in the elderly due to spinal cord lesions: association with malignancy.

A retrospective study showed that paraplegia and quadriplegia due to spinal cord lesions occurred with a frequency of 1 in 500 admissions to a geriatric department. These cases predominantly were caused by malignant disease, particularly of the bronchus. However, elderly patients presenting to other hospital departments included a far higher proportion of cases with benign causes, particularly cervical spondylosis which affects patients of lower average age. Male patients predominated in both malignant and benign categories.

The epidemiology of serious adverse drug reactions among the elderly.

Although the incidence and prevalence of serious adverse drug reactions (ADRs) in the elderly cannot be accurately stated, published estimates appear to be unchanged since the earliest reports in the 1960s. Whereas heightened awareness of the problem may weigh in favour of a reduction in ADR frequency, the dramatic increase in the number and availability of therapeutic agents has undoubtedly contributed to the observed high proportion of drug-induced morbidity among acute geriatric hospital admissions. No single drug or drug class is of particular concern since none appears to cause serious morbidity out of proportion with its use. Although numerous studies have sought to identify risk factors for ADRs, the only truly independent predictor is the absolute number of concurrently used medications. However, other studies indicate that there is poor doctor-patient agreement regarding a patient's drug regimen, and interventions that aim to reduce the incidence of ADRs have failed to demonstrate a positive effect. Thus at present the most rational approach would appear to be to establish an accurate knowledge of the patients drug regimens: once this is known one can attempt to rationally minimise the number of medications without compromising therapeutic goals.

Retrospective study of polymyositis in Auckland over 10 years.

Twenty-nine patients with polymyositis and dermatomyositis seen at the three main hospitals in Auckland between 1967 and 1977 have been reviewed. Of the five diagnostic criteria used, weakness of proximal muscles (including neck flexors) was the single most important clinical diagnostic feature. The certainty of diagnosis was increased if investigations included a range of muscle enzymes, electromyography and muscle biopsy. The incidence of underlying malignancy was 10 percent. Patients with polymyositis or dermatomyositis with an associated connective tissue disorder responded better to treatment and pursued a more benign course.

Transitional care for young adult survivors of childhood cancer.

OBJECTIVES: To review the obstacles and barriers to providing optimal care to young adult cancer survivors and discuss the transition from pediatric to adult health care system. DATA SOURCES: Published articles and textbook chapters. CONCLUSIONS: More than 70% of children diagnosed with cancer between birth and 14 years of age will be cured of their primary disease. Because of multiple physical and psychosocial risk factors imposed by their therapy and previous disease, childhood cancer survivors require life-long care. IMPLICATIONS FOR NURSING PRACTICE: Health care providers must be aware of the unique needs of these individuals for life-long follow-up and assist in facilitating this transition process.

The anatomy and histology of the reproductive tract of the male Babirusa (Babyrousa celebensis).

The anatomy and histology of the reproduction organs of the male Babirusa (Babyrousa celebensis) were studied in 21 specimens collected between birth and approximately 17 years of age. In adult animals the testes were located in a subanal position against the caudal surface of the thigh musculature. Average adult testis length was 68.9 ± 5.1 mm, width was 40.3 ± 5.7 mm, and depth was 47.9 ± 7.0 mm (N = 11). The average combined adult testicular weight was estimated to be 82.7 ± 23.2 g (N = 11). The testes of newborn Babyrousa had descended through the inguinal canal into the scrotum before birth. Adult seminiferous tubules had an average diameter of 199 ± 33.6 µm (N = 9) and were randomly distributed among a smaller volume of Leydig cells. Connective tissue was sparse. In one 13-month-old prepubertal animal the diameter of the seminiferous tubules was 85.3 ± 16.1 µm (N = 7). The spermatozoa was 42.2 ± 4.9 µm (N = 19) long and had a flat, paddle shaped head, 6.3 ± 0.6 µm (N = 50) long, 3.9 ± 0.5 µm (N = 47) wide, and a thickness of approximately 0.5 µm. An apical ridge along its front represented the acrosome. The two adult vesicular glands each had an irregular shape and were approximately 48.7 ± 7.4 mm long, 25.6 ± 4.3 mm wide, and 20.6 ± 8.7 mm deep (N = 6). The prostate, comprising a corpus and disseminate parts, lay ventral to the vesicular glands partly embedded in the dorsal wall of the urethra. The paired adult bulbourethral glands were approximately shaped like prolate (elongated) spheroids and had a length of 51.2 ± 14.2 mm, a width of 22.6 ± 4.5 mm, and a depth of 14.4 ± 4.5 mm (N = 7). The secretions from the bulbourethral glands drained into the urethral recess, which in adults measured approximately 10 to 14 mm in length and was located caudodorsal to a narrowing of the pelvic urethra. The penis was 330 ± 16 mm long and 8.2 ± 0.6 mm in diameter, and rotated approximately two and a half turns counterclockwise along its longitudinal axis toward its free end. The small prepucial diverticulum situated dorsocranial to the penis tip in adult and prepubertal Babyrousa, in adults measured 22.0 ± 1 mm in length and 17.5 ± 2.6 mm (N = 3) in width.

Anatomy and histology of the reproductive tract of the female Babirusa (Babyrousa celebensis).

The anatomy and histology of the female reproductive tract of the Indonesian wild pig Babyrousa celebensis was studied by means of reproductive tracts obtained from seven animals aged between two and 22 years of age. The ovary appeared to have the ability to ovulate up to four ova at one time. However, the combined ovarian output seemed to average 1.86 ova. Ovulation can take place at any time from puberty to old age (22 years). The opening to the uterine tube was indicated by a 'flower-like' array of tall, broad epithelial 'petals' arising from the luminal surface of the funnel. The mucosal surfaces of these structures were covered in a mixture of prominent ciliated cells and bulbous secretory cells. The uterine tube followed a tightly convoluted path to the tip of the uterine horn. The uterus was proportionately short. The anatomical construction of the uterus was similar to those of other suids in that the columnar endometrium was heavily folded, there was a rich supply of uterine glands in the lamina propria, and the uterus was provided with a good blood supply. The cervix was thick walled and had a spiral lumen.

Changing views on diverticular disease as a cause of gastro-intestinal bleeding.

Over the past 60 years there has been continuing controversy and changing views about the relative importance of diverticular disease as a cause of gastro-intestinal haemorrhage. In the 1920s neoplasms were thought to be the commonest cause of colonic bleeding, then in the 1950s diverticulitis and subsequently diverticulosis. However, at that time the diagnosis of diverticular haemorrhage was mostly one of exclusion. In the 1960s an attempt was made to identify the site of bleeding and it was found that even though diverticula are mostly in the left colon, bleeding occurred from the right colon. A partial explanation for this came with the advent of arteriography and the discovery of caecal angiodysplasias. The relative importance of the two conditions remains uncertain but it is clear that, in patients with gastro-intestinal haemorrhage, the presence of diverticula should not stop a thorough search for other causes of bleeding.

Laryngographic analysis of child-directed speech.

This paper reports the results of a small-scale study of mother-child interactions using electrolaryngography to measure mean, mode and range of fundamental frequency variation. The mother-child results are compared with those obtained from recordings of the same subjects in conversation with an adult. The methodology employed allowed statistics to be derived from very much larger samples of speech than have hitherto been used in the literature on child-directed speech. The main findings were that measures of central tendency are higher for adult-child interactions than for adult-adult conversations and the range of fundamental frequency greater. This expansion of the range is effected by increasing the upper limit of the range.

Day hospital rehabilitation--effectiveness and cost in the elderly: a randomised controlled trial.

The effectiveness and cost of day hospital care in rehabilitation were studied in a randomised controlled trial in 120 elderly patients who were assessed at referral and six weeks and five months later in activities of daily living skills and mood. Day hospital patients were compared with a control group, who were managed as they would have been before the availability of day hospital care. Day hospital patients showed a significant improvement in performance of activities of daily living at six weeks but not at five months; however, they had a sustained improvement in mood. The cost of day hospital rehabilitation was one third greater than that of rehabilitation by alternative means. In its current form the geriatric day hospital is not a cheap alternative to other means of rehabilitation. Expensive components of the day hospital should be critically re-examined and renewed emphasis placed on sufficient inpatient beds, domiciliary services, and day care centres.

Effects of nedocromil sodium, cromolyn sodium, and a placebo in exercise-induced asthma.

The incidence and severity of exercise-induced asthma were determined in nineteen asthmatic patients who performed eight minutes of exercise following four treatments administered in a random order. The treatments were nedocromil sodium, cromolyn sodium, placebo, and no treatment. It was concluded that nedocromil sodium (8 mg) and cromolyn sodium (4 mg) provide equal protection against exercise-induced asthma.

Seminal improvement following repair of ultrasound detected subclinical varicoceles.

PURPOSE: We determined whether repair of subclinical varicoceles detected by scrotal duplex ultrasonography results in significant seminal improvement and identified the best ultrasonographic criteria to use in the selection of patients for subclinical varicocelectomy. MATERIALS AND METHODS: Of 256 consecutive infertile men being evaluated by physical examination and color duplex scrotal ultrasonography 76 underwent varicocele repair and were followed with serial semen analyses. All subclinical varicoceles were confirmed by venography. The outcome of varicocelectomy was determined by changes in total motile sperm count and compared among patients with different clinical grades of varicoceles and ultrasonographically measured in veins sizes. RESULTS: A significant overlap was observed between ultrasonographically measured venous diameter and clinical grade of varicocele. There was no correlation between venous diameter and postoperative outcome when controlled for clinical grade. Significant postoperative improvement in semen parameters was noted in 67% of patients with clinical and only 41% with subclinical varicocelectomy (p<0.05). The best ultrasonographic cutoff to predict a positive outcome after subclinical varicocelectomy was venous diameter greater than 3mm. Patients with larger clinical varicoceles had greater postoperative seminal improvement than those with small or subclinical varicoceles regardless of baseline sperm count. CONCLUSION: Varicocele size has a direct impact on the probability and amount of seminal improvement after varicocelectomy. Outcome following subclinical varicocelectomy is significantly less than after repair of clinical varicoceles. Although 41% of patients with subclinical varicoceles had significant postoperative improvement in semen parameters, an equal number were worse postoperatively and, thus, mean sperm count was unchanged for the group. The results of our study suggest that subclinical varicocelectomy is of questionable benefit.

Effects of the antiandrogen, cyproterone acetate, on the induction of papillomas, DNA synthesis and ornithine decarboxylase activity in mouse skin.

The antiandrogen, cyproterone acetate (CPA), applied simultaneously with 12-O-tetradecanoylphorbol-13-acetate (TPA) to the dorsal skin of male and female SENCAR mice initiated with 7,12-dimethylbenz[a]anthracene inhibited the production of papillomas of the skin. Although 125 and 250 micrograms of CPA had no effect on the incidence of papillomas per mouse, 500 micrograms of CPA inhibited papilloma production by 95% and 91% in female mice after 20 and 37 weeks of promotion, respectively. Testosterone propionate only partially blocked the inhibitory effect of CPA. In male mice 500 micrograms and 1 mg of CPA inhibited papilloma production by 77% and 88%, respectively. In the two-stage promotion protocol 500 micrograms of CPA was ineffective as an inhibitor when it was applied with TPA during the 1st stage but inhibited papilloma production by 71% when it was applied with mezerein during the 2nd stage. CPA was also observed to inhibit TPA-stimulated epidermal DNA synthesis and inflammation but had no effect on TPA-induced epidermal ornithine decarboxylase activity.

Validation of a brief screening test for depression in the elderly.

This paper describes the clinical validation of the 10-question Short Zung Interviewer-assisted Depression Rating Scale (Short Zung I.D.S.) which has been derived from the 20-question Zung Self-rating Depression Scale (Zung S.D.S) for use in the elderly. The Short Zung I.D.S. was administered to 104 elderly volunteers from the community and to 33 elderly depressed patients assessed by a psychiatrist. The mean scores (41.3 and 81.0, respectively) were significantly different (P less than 0.0001). The Short Zung I.D.S. has proved to be a useful brief screening test for depression in the elderly and should be of value in measuring changes in mood.

Are medication record cards useful?

OBJECTIVE: To assess the use of patient-held medication record cards and their acceptability to patients and doctors. DESIGN: Prospective 12-month study with data collection at baseline and on three subsequent occasions at four-monthly intervals. PATIENTS AND SETTING: 187 patients with a mean age of 78.4 years (range, 60-101) were taking a mean of 5.8 medications each (range, 1-18). They lived on Sydney's lower north shore and were able to care for themselves. MAIN OUTCOME MEASURES: Availability of card on request, frequency of use, status of recorders and accuracy of records (checked by inspection of medications at home). RESULTS: Most patients retained their cards, but the proportion who presented it to their doctor fell from 61% to 23% over the 12 months (P < 0.0001), and the proportion with accurately recorded drug regimens ranged from 20% down to 16%. Of the 75 regimens written exclusively by general practitioners in the 12 months, only 19 (25%) were consistent with what the patients were actually taking. CONCLUSION: Medication record cards introduced into the doctor-patient relationship by a "third-party" are unlikely to result in better quality use of medicines.

Functional ability of patients to manage medication packaging: a survey of geriatric inpatients.

This study measured the prevalence of difficulty experienced by elderly inpatients in opening and removing tablets from a range of common commercial medication packagings and in breaking a bar-scored tablet in half. One hundred and twenty elderly patients admitted to a teaching hospital acute geriatric service were tested for their ability to open the container and remove a tablet from it. They were rated as 'able' or 'unable' to do so. In all, 94 patients (78.3%) were unable to break a tablet or open one or more of the containers. Of the 111 patients taking medication at the time of their admission, 46 (41.4%) were unable to perform one or more tasks necessary to gain access to medications in their own treatment regimen. The factors that were significantly and independently associated with inability to open containers were poor vision, impaired general cognitive function, and female sex. Many of the drug packagings in common use significantly impede access by elderly patients to their medications.

Age-associated change in pain threshold measured by transcutaneous neuronal electrical stimulation.

The measurement of cutaneous pain threshold using the Neuromod Selectra Model 7750 Transcutaneous Neuronal Electrical Stimulator is described. Pain threshold, measured in 520 healthy volunteers aged 5-105 years, increased with age. Consistent values were obtained in 22 healthy volunteers on three successive days. Pain threshold may be rapidly measured by this method which is potentially of value in the assessment of patients with neurological deficits.

Liver damage from long-term methyltestosterone.

Of 60 patients (42 female transsexuals and 18 impotent males) receiving long-term therapy with methyltestosterone 50 mg three times a day, 19 had abnormal liver-function tests and 33 out of 52 had abnormal liver scans, particularly those who had been treated for more than a year. Liver biopsy specimens showed accumulation of hepatocytes in the liver cords and within the walls of centrilobular veins, and early peliosis hepatis. One patient had a hepatic adenoma. Of the androgens, only 17alpha-alkylated steroids seem to be implicated in the development of cholestatic jaundice, peliosis hepatis, and liver tumours.