One hundred and six patients with uncomplicated mild to moderate essential hypertension received nitrendipine 10 mg twice a day or 20 mg once a day in a double-blind, randomized design. At the end of the dosing interval, supine and standing blood pressures were lowered 6/4 and 6/3 mm Hg respectively with the former regimen, and 2/3 mm Hg with the latter. In 10 patients, blood pressure variability through the dosing interval was not increased by nitrendipine 10 mg twice daily, but in another 10, 20 mg daily increased the variability by 28% compared to placebo. Significantly more patients had adverse effects with 20 mg daily than 10 mg twice daily; and both regimens caused more side effects than placebo. In 20 patients, serum glucose levels did not change significantly during treatment with nitrendipine, but in 10 of those with noninsulin-dependent diabetes, the range of maximum plasma insulin in response to a high-carbohydrate meal was 7 times as great during treatment with nitrendipine as it was during treatment with placebo. Nitrendipine lowers blood pressure when given once or twice daily, but twice-daily administration appears to be better tolerated.

Adult↗

PubMedDate not supplied

Iridium 192 implantation of squamous cell carcinomas of the oropharynx.

From 1970 to 1984, 127 patients with T1 or T2 carcinomas of the oropharynx were treated with external irradiation to the primary tumor and neck nodes to a dose of 45 Gy, followed by a further 30 Gy delivered by an iridium 192 implant to the primary tumor. Patients with clinically positive nodes had either further neck irradiation using electrons or a neck dissection. Crude 5-year disease-free survival was 66% for tonsillar carcinomas, 43% for soft palate, and 51% for base of tongue. Local control was 98%, 85%, and 76%, respectively. Regional control was 97% for N0 patients and 88% for N1-3. Soft tissue ulceration occurred in 17 patients; all healed spontaneously. The high rate of local control achieved in these patients while preserving function and minimizing xerostomia supports the use of this approach.

Adult↗

PubMedDate not supplied

Pediatric use of emergency departments.

This cross-sectional survey examined the use of emergency services by children, from birth to 16 years of age, in two urban teaching hospitals. A retrospective chart survey design was used to obtain data on the prevalence of types of patient problems; the pattern of use, including time of day and day of week; and decisions regarding patient disposition. A random sample of 10% of the average monthly pediatric emergency visits was obtained for a 12-month period and relevant data were extracted by trained research assistants. Variation in the presenting health care problems by age group, season of the year, and by time of day and day of the week was found. Approximately 50% of visits involved such primary health care problems as soft tissue injuries, and respiratory and digestive tract infections. Possible reasons for this use of emergency departments for primary care needs are discussed and strategies are suggested for the provision of a better "fit" between consumer demand and health care services.

Adolescent↗

PubMedDate not supplied

The impact of personal and situational variables on career patterns among nurses from three types of educational programs.

Relationships between educational preparation and employment choices were investigated in a study of the career paths of nursing graduates from three types of educational programs: a community college diploma program, a generic baccalaureate program, and a postdiploma baccalaureate program. Selected personal and work-related correlates of career paths for the three groups also were explored. All available graduates for the years 1984 to 1990 from the three programs (n = 1,544) were sent a self-administered questionnaire. Data were collected concerning demographic variables, employment details, ongoing professional development, and level of satisfaction with nursing. Analysis of the data demonstrated clear variations in the career paths of the three groups of graduates, supporting the belief that the type of educational program does indeed have a steering effect on the subsequent career choices of these nurses.

Adult↗

PubMedDate not supplied

Baculovirus expression, purification and evaluation of recombinant pneumococcal surface adhesin A of Streptococcus pneumoniae.

Pneumococcal surface adhesin A (PsaA), with a molecular mass of approximately 37 kD by SDS-PAGE, is a common surface protein expressed by all 90 serotypes of Streptococcus pneumoniae. S. pneumoniae serotype 6B genomic DNA was amplified to generate a DNA fragment carrying the full-length psaA sequence and was cloned into a baculovirus expression system. We expressed either cell-associated or cell-free nonfusion PsaA polypeptides using two insect cell lines, Spodoptera frugiperda (Sf9) and Trichoplusia ni 5B1-4 (High-Five). Recombinant PsaA (rPsaA) polypeptides were partially purified by partitioning in PBS/Triton X-114 buffers and by weakly basic ion exchange filter chromatography. Membrane-bound 'hydrophobic rPsaA' (hrPsaA) expressed by either Sf9 or High-Five cells had a molecular mass of approximately 38 kD by SDS-PAGE and partitioned in a Triton X-114 phase, it reacted with both rabbit polyclonal and five monoclonal anti-PsaA antibodies by dot blot or Western blot analysis. High-Five-cell-expressed 'soluble rPsaA' (srPsaA) with a molecular mass of approximately 37 kD by SDS-PAGE, was isolated from the serum-free culture medium and did not partition in the Triton X-114 phase; it reacted with anti-PsaA rabbit polyclonal and mouse monoclonal antibodies by ELISA and Western blot analysis. Both rPsaA polypeptide forms were immunogenic in Swiss-Webster adult female mice. In an infant mouse model of bacteremia, survival rates for mice given mouse anti-rPsaA immune serum (from mice immunized with High-Five-expressed srPsaA; 20 microl, 1:50,000 titer) 24 h before bacteremic challenge were greater than for the control group (48 h postchallenge, 20 vs. 90% survival rates) when challenged with S. pneumoniae serotype 6B. These results indicate that rPsaA is immunogenic and elicits protective antibody in mice similar to native protein.

Adhesins, Bacterial↗