Exercise-induced effects on a gym atmosphere.

We report results of analysis of a month-long measurement of indoor air and environment quality parameters in one gym during sporting activities such as football, basketball, volleyball, badminton, boxing, and fitness. We have determined an average single person's contribution to the increase of temperature, humidity, and dust concentration in the gym air volume of 12500 m(3) : during 90-min exercise performed at an average heart rate of 143 ± 10 bpm, a single person evaporated 0.94 kg of water into the air by sweating, contributed 0.03 K to the air temperature rise and added 1.5 µg/m(3) and 5 ng/m(3) to the indoor concentration of inhalable particles (PM10 ) and Ca concentration, respectively. As the breathing at the observed exercise intensity was about three times faster with respect to the resting condition and as the exercise-induced PM10 concentration was about two times larger than outdoors, a sportsman in the gym would receive about a sixfold higher dose of PM10 inside than he/she would have received at rest outside.

Time-resolved laser-induced desorption spectroscopy (LIDS) for quantified in-situ hydrogen isotope retention measurement and removal from plasma facing materials.

A laboratory scale laser induced thermal desorption spectroscopy system is developed and tested on tungsten-deuterium and titanium-deuterium codeposits, and its feasibility as a hydrogenic inventory measurement diagnostic is demonstrated over a range of retention values from 5 × 1019 m-2 to 7 × 1023 m-2 for absorbed laser power densities as low as 8 MW m-2. Codeposit layer samples are grown by magnetron sputtering and immersed in a weak argon rf plasma. A 1 kW fiber laser (λ = 1100 nm) heats the samples up to a peak surface temperature ranging from 900 to 1500 K using pulse widths of 0.5 and 1 s. Spectral line emission from Balmer series Dα and Hα from thermally desorbed deuterium and hydrogen, as well as line emission from argon, are monitored as a function of time using an optical spectrometer with maximum temporal resolution of 1 ms. To correct for wall recycling and pumping speed, and to accurately measure the time evolution of the laser-induced thermal desorption, the raw Dα signal is deconvolved with the system response function, which is obtained by injecting a short burst of D2 to approximate an impulse. Calibration is done with a standard D2 leak, and laser induced desorption spectroscopy deuterium retention values are found to be in good agreement with companion measurements made using conventional temperature programmed desorption on samples from the same codeposit batch.

Retention of internal medicine physicians in the U.S. Army.

There is currently no reliable information to predict the retention rate of internal medicine physicians in the U.S. Army. A retrospective study was conducted of internal medicine physicians who had trained in the U.S. Army Graduate Medical Education Program during the years 1975-1988. Positive predictors for retention included subspecialty training, prior military service, and graduation from the U.S. Military Academy or the Uniformed Services University of the Health Sciences.

Primary cardiac angiosarcoma: a review and case report.

Primary cardiac tumors, both benign and malignant, are rare. Approximately 25% of primary cardiac tumors are malignant, with the majority of these being sarcomas. One of the most common sarcomas is angiosarcoma. A case of primary angiosarcoma of the heart is presented which illustrates several of the features of this malignancy. The administration of systemic chemotherapy resulted in a brief stabilization of disease before progression and subsequent death occurred. Clinical signs and symptoms of cardiac tumors and diagnostic testing are discussed. Therapeutic options and efficacy of therapy are reviewed.

Gastric Hodgkin's disease: recurrence after autologous bone marrow transplant.

Gastric involvement in Hodgkin's disease is rare. A case of gastric Hodgkin's disease occurring after autologous bone marrow transplantation is presented. A retrospective review of 339 cases of Hodgkin's disease in the Tumor Registry at Brooke Army Medical Center revealed six additional cases of documented gastric involvement. These six cases plus the case report are reviewed as well as the available literature on gastric Hodgkin's disease.

National Guard training: Fort Irwin MEDDAC experience during Operation Desert Storm.

The expansion of the USA MEDDAC, Fort Irwin, California, during Operation Desert Storm is described. During Operation Desert Storm, Fort Irwin and the National Training Center was responsible for training the 48th Separate Infantry Brigade National Guard from Georgia. The impact of this training upon the MEDDAC is described.

Impact of units on rotation at the National Training Center: the Fort Irwin MEDDAC experience.

Soldiers who experience orthopedic injuries during their training cycle at the National Training Center have a major impact on the Fort Irwin MEDDAC. The majority of hospital referrals from the field medical companies and admissions occur during the training days 7 through 20. Vehicular and other training accidents result in a mini-MASCAL at least once during the rotation, requiring the activation of selected MEDDAC personnel.

Unproven (unorthodox) cancer treatments: a guide for healthcare professionals.

Patients often seek out unorthodox therapies, either in lieu of, or in addition to, conventional treatments. It is essential that healthcare providers have both a clear understanding of why patients pursue these unorthodox treatments and a basic knowledge of current unorthodox treatments. A historical overview is presented as well as a review of the current more popular types of unorthodox therapies.

Breast cancer stage at diagnosis: Caucasians versus Afro-Americans.

In the Department of Defense health care system, all women have the same ability to access health care. Thus, there should be no racial differences in stage at diagnosis solely based on ability to seek health care. A retrospective review of breast cancer cases from 1976-1992 was conducted to determine if there were any differences in stage at diagnosis between Caucasian and Afro-American females. Data was available for 6414 Caucasian and 746 Afro-American females. Stage at diagnosis was similar for both groups. However, Afro-Americans had fewer tumors < or = 1.0 cm than Caucasians. Afro-American females were younger (median age 50 years versus 58 years in Caucasians). Twenty-four per cent of Afro-Americans were < 40 years old compared to only 9% Caucasians. When access to care is not an issue, there are no racial differences in stage of breast cancer at diagnosis.

Breast cancer stage at diagnosis: Caucasians versus Hispanics.

In the Department of Defense health care system, all women have the same ability to access health care. Thus, there should be no racial differences in stage at diagnosis solely based on ability to seek health care. A retrospective review of breast cancer cases from 1980-1992 was conducted to determine if there were any differences in stage at diagnosis between Caucasian and Hispanic females. Data was available for 6134 Caucasian and 182 Hispanic females. Although not statistically significant, Hispanic females had fewer Stage I (41% versus 53%) and more Stage IIA (37% versus 28%) breast cancers than Caucasian females. Hispanic females had statistically fewer tumors < or = 1 cm (p < 0.001). Caucasian females were older (median age 58 years) at presentation than Hispanic females (median age 51 years). Significantly (p = 0.002) more Hispanic females (44%) were < 50 years old compared to Caucasian females (28%). When access to care is not an issue, Hispanic females tended to present at a more advanced stage although this did not reach statistical significance. Hispanic females with breast cancer were significantly younger than Caucasian females.

Lymphomatoid granulomatosis. A case for aggressive therapy.

Lymphomatoid granulomatosis is an uncommon disorder with features of vasculitis and lymphoma. Treatment has usually consisted of steroids and, occasionally, single cytotoxic drugs, but prognosis remains poor. The authors report a patient with life-threatening disease treated successfully with combination chemotherapy consisting of methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin (MACOP-B) who achieved complete remission and remains disease-free over 3 years from diagnosis. Justification for an aggressive therapeutic approach to this disease is presented.

Management of cardiac metastasis from malignant fibrous histiocytoma.

The management of a case of malignant fibrous histiocytoma with cardiac metastasis is described in this article. Because of the extent of disease in the right ventricle, surgical resection was impossible. After disease progression on chemotherapy, a right atrial to pulmonary artery shunt was performed. Although the surgical procedure was successful, the patient died from progressive disease. Management of cardiac metastasis is also discussed.

Malignant melanoma.

Family physicians should be aware of the early signs of malignant melanoma, as well as measures that can be taken to prevent the disease. Etiologic factors for melanoma include sunburns, particularly those occurring early in life, giant congenital nevi, dysplastic nevi and the presence of numerous nevi. The four major subtypes of melanoma are lentigo maligna, superficial spreading melanoma, acral lentiginous melanoma and nodular melanoma. Diagnosis is based on excisional, incisional or punch biopsy. The crude five-year survival rate for malignant melanoma is 81 percent, but survival depends on stage of disease, anatomic site, the patient's age and sex, histologic factors and clinical subtype. Surgical excision is the usual treatment for primary melanoma. Surgery, radiation therapy and chemotherapy are used in the management of metastatic disease, but the prognosis following the development of metastases remains poor. Family physicians can affect survival rates by improving early detection, promoting patient awareness and self-examination, and encouraging regular physical examination of patients who are at increased risk of melanoma.

Intrapleural tetracycline in malignant pleural effusions. A randomized study.

Intrapleural instillation of tetracycline (TCN) has been shown to be effective in preventing the recurrence of malignant pleural effusions. Although the precise mechanism of action is unknown, it has been postulated that the pH of the TCN solution may be an important factor. Thirty patients with malignant pleural effusions were randomized in a double-blind trial to receive intrapleural administration of either 500 mg of tetracycline in solution (pH = 2.8) or a solution of similar pH and appearance. All patients had chest tube drainage of their effusion. There were 24/30 patients evaluable. There were 9/13 patients in the TCN group and 1/9 patients in the control group who had no reaccumulation of fluid (P less than 0.05). These results would suggest that the efficacy of TCN as a sclerosing agent is not related to its acidic pH and that intrapleural TCN is more effective than chest tube drainage alone for control of malignant effusions.

Evaluation of bone pain in carcinoma of the lung. Role of the localized false-negative scan.

False-negative bone scans localized to the vertebral column were detected in ten patients with primary carcinoma of the lung. All patients had macroscopic vertebral metastases at autopsy despite recent normal technetium Tc 99m bone scans and skeletal roentgenograms. Bone scans were 96% accurate in detecting nonvertebral metastases that were grossly visible at postmortem, with seven patients demonstrating multiple skeletal defects. False-negative studies of the vertebral column apparently prevented both the clinician and radiotherapist from treating symptomatic metastases in eight patients despite the administration of radiotherapy to other scan-positive symptomatic areas or to the primary tumor site.

Thymic carcinoma: clinical findings in two patients with extrathoracic metastases.

Two patients with widely metastatic thymic carcinoma form the basis for this review. Evidence of local tumor invasion at initial operation may be the best predictor of risk for relapse. Combination chemotherapy including cisplatin may be of benefit for some patients with metastatic disease.

Comparison of alternating to nonalternating chemotherapy regimens for non-small cell lung cancer.

Forty-seven patients with stage III lung cancer from four institutions in the Denver area were entered in a study comparing two regimens of chemotherapy. The patients were randomized into two groups: Group A received lomustine, cyclophosphamide, vincristine, cisplatin, and doxorubicin monthly; Group B received the five-drug regimen on Months 1, 3, and 5 and received 5-FU by constant infusion, methotrexate, and mitomycin on Months 2, 4, and 6. The age, extent of disease, Karnofsky score, prior therapy, and average number of chemotherapy courses received in each group were comparable. The median survival in Group A was 265 days and in Group B was 163 days (P greater than 0.25). There does not seem to be an advantage in survival in patients who are treated with the eight-drug regimen over the five-drug regimen.