Duration of anticoagulation for deep-vein thrombosis and pulmonary embolism.
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Anticoagulants↗
Biomedical subjects
L Hill
Publications and source records attributed to L Hill.
Teaching complex nursing interventions: integrating holistic and traditional behavior.
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Coma↗
Using health risk appraisal in clinical practice.
The Scientific Board of the California Medical Association presents the following inventory of items of progress in preventive medicine and public health. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, or scholars to stay abreast of these items of progress in preventive medicine and public health that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another. The items of progress listed below were selected by the Advisory Panel to the Section on Preventive Medicine and Public Health of the California Medical Association, and the summaries were prepared under its direction.
Health Status Indicators↗
Protection by cysteine esters against chemically induced pulmonary oedema.
Perfluoroisobutene (PFIB) is a hydrophobic reactive gas produced by the pyrolysis of polytetrafluoroethane which induces pulmonary oedema similar to that induced by phosgene when inhaled. When a lethal dose is inhaled by Porton strain rats total non-protein thiol (NPSH) and glutathione (GSH) in the lung are reduced by between 30 and 49%, respectively. If the endogenous levels of thiols in the lung are reduced by pretreatment with buthionine sulfoximine (BSO) 16 hr before exposure to PFIB, the rats become more susceptible to the effects of the gas. The effect of BSO pretreatment on toxicity was prevented by pretreatment 30 min before exposure, with 5 mmol/kg N-acetylcysteine (NAc). NAc increased the levels of cysteine (CySH) in the lung by 150% and GSH was unaffected. Similarly pretreatment with 3 mmol/kg CySH also protected against toxicity and raised CySH levels by 100%. A series of cysteine esters and cystine dimethyl ester (CDME) have been synthesised which selectively raise lung levels of CySH in the rat lungs after intraperitoneal (i.p.) injection. The methyl ester and CDME raised lung levels of CySH by 4000 and 2000%, respectively, 10 min after i.p. injection whilst GSH levels remained unchanged. Cysteine isopropyl ester raised lung levels of CySH by 10,600% but liver levels by only 1400%. All esters except the t-butyl ester (CTBE) also raised maximal plasma levels of NPSH by up to 500%; however, when NAc was injected plasma levels increased by over 1500%. Rats treated with these esters at 3 mmol/kg and with NAc at 5 mmol/kg were protected against lethal doses of PFIB in all cases except when CTBE was used. It appears that these cysteine esters may distribute preferentially into the lung, unlike NAc. The selective enhancement of pulmonary CySH levels may provide a method for the protection of lungs against inhaled reactive toxicants by increasing intracellular CySH. Levels of CySH may also be raised in epithelial lining fluid thus reducing access of gaseous toxicants to pulmonary tissue.
Acetylcysteine↗
Ectrodactyly of hands and feet in a child with a complex translocation including 7q21.2.
A three-way translocation involving a break point of 7q21.2 was found in a boy with tetramelic ectrodactyly.
Chromosomes, Human, Pair 7↗
Pallister-Killian syndrome diagnosed by chorionic villus sampling.
The first prenatal diagnosis of Pallister-Killian syndrome by chorionic villus sampling is presented. Fetal hydrops was noted on ultrasound in early pregnancy, and the karyotype revealed isochromosome 12p mosaicism.
Adult↗
Monoclonal antibody L6-daunomycin conjugates constructed to release free drug at the lower pH of tumor tissue.
Measurements in cancer patients showed that the pH of tumors averages 0.8 unit lower than that of the surrounding normal tissues, confirming published work. Based on this, the anti-carcinoma monoclonal antibody (mAb) L6 was used to prepare immunoconjugates with daunomycin (DM), the drug being released at the acidic pH of the tumor. A direct linking of the aconitic derivative of DM (AcoDM) to mAb L6 led to conjugates that either had a low drug/antibody ratio (less than 5:1) or precipitated in vitro. In order to increase the drug load and avoid precipitation, several biopolymers were tested as spacers between the drug and the L6. To attach the polymer derivative to the mAb, the former was maleimidized and the mAb was thiolated. The AcoM/mAb ratio obtained was 20, and the mAb retained its highly specific binding to tumor cells. At pH 6 the AcoDM-L6 conjugate was toxic to cultured C-3347 carcinoma cells with an inhibitory concentration (IC50) of 5 micrograms/ml. The conjugate was less effective than the free DM with an IC50 of 0.2 micrograms/ml. The L6 alone was not toxic. At a tumor pH of 6.5, 15% of the AcoDM was released. The amount of released drug reached a maximum 24-48 h after exposure to the acidic medium. In vivo localization studies demonstrated a similar tumor uptake of the conjugate and mAb L6 with 18% of the injected dose/g tumor and a maximum uptake in tumor 48 h after injection. Our data indicate that it is possible to construct conjugates based on a pH-sensitive linker that can be targeted successfully to a tumor with release of a portion of the drug at the tumor site, but testing is needed to establish whether such release has anti-tumor activity in vivo and offers an advantage over treatment with unconjugated drug.
Aged↗
Some observations on variations in filament overlap in tetanized muscle fibres and fibres stretched during a tetanus, detected in the electron microscope after rapid fixation.
Anomalous tension development which would not be predicted from the descending limb of the length-tension curve occurs during prolonged tetani and after stretch during a tetanus. Variations in filament overlap might account for all or part of the tension enhancement. Fibres isolated from frog skeletal muscle were rapidly fixed during a tetanus with mercuric chloride in ethanol and chloroform so that the correct alignment of the filaments in the overlap zones was preserved. The fibres were examined in polarized light with compensation, and in the electron microscope. There were variations in striation spacing along the length of the fibres, and severe shortening with contraction bands near the tendon insertions, confirming observations made by others on live fibres. Many variations in filament overlap which would not be detectable by light microscopy or laser diffraction were seen in the electron microscope. In a pilot study we measured differences in the width of the overlap zones between half-sarcomeres in a small area and within individual half-sarcomeres. In the latter case the variations were greater in a fibre which developed creep of tension and one which did not. Even greater variations were seen in three fibres stretched during a tetanus, and, in two of these, there were some grossly elongated half-sarcomeres in which the filaments had pulled out of the overlap zones, leaving gaps.
Animals↗
Women's changing work roles: implications for the progress of the dietetic profession.
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Dietetics↗
Radiotherapy of brain tumours: reduced irradiation of normal brain.
We analysed the dose-volume distribution in normal brain in eight patients undergoing localized external beam radiotherapy for brain tumours. The results have been represented as integral dose-volume histograms and show that large volumes of normal brain receive clinically significant doses of radiation. A mean of 43% (range 24%-57%) of normal brain volume received more than 50% and a mean of 22% (range 9%-38%) received more than 85% of the maximum tumour dose. The amount of normal brain irradiated increased with enlarging target volume. With the use of customized shielding blocks the mean volume reduction of normal brain receiving more than 50% and 85% maximum tumour dose was 178 ml (median 183 ml; range 89-244 ml) and 110 ml (median 110 ml; 40-179 ml) respectively. This represents an average reduction of 13% and 8% of normal brain volume. Although clinically important this may not be sufficient for a significant improvement in therapeutic ratio.
Brain Neoplasms↗
Exit-site care and exit-site infection in continuous ambulatory peritoneal dialysis (CAPD): results of a randomized multicenter trial.
A total of 127 patients from 8 hospitals were randomized into 1 of 2 exit-site care regimes to evaluate their effect on rate of exit-site infection (ESI). Group 1 used povidone iodine and nonocclusive dressings changed 2 to 3 times weekly; Group 2 simply cleansed the exit site with nondisinfectant soap and water. Incidence, cause, duration, and treatment of ESI and peritonitis (P) were noted. Groups were analysed for age, sex, end-stage renal disease (ESRD), catheter, and systems. Total cumulative follow up time was 95.6 years. There was a significantly higher rate (p = 0.0183) of ESI in Group 2 (soap and water). The mean rate of ESI was 0.27 episodes/patient year for Group 1 versus 0.71 episodes/patient year for Group 2. Rates of P for the two groups were not significantly different (p greater than 0.50): 0.446 episodes/year for Group 1 versus 0.574 episodes/year for Group 2. S. aureus was responsible for 83% of ESI in Group 1 and 67% of ESI in Group 2. Protective dressing with a disinfectant is associated with significantly less ESI than minimum care. However, further research in exit-site care aimed specifically at reducing S. aureus infection is still required.
Adult↗
Identification and characterization of a Mr 50,000 adrenal protein in human hepatocellular carcinoma.
A Mr 50,000 cell surface protein antigen (p50) was identified on a human hepatocellular carcinoma derived cell line (FOCUS) by two monoclonal antibodies (SF 31 and SF 90). This antigen was subsequently shown to be expressed in vivo in human hepatocellular carcinoma. All 18 tumors tested by Western immunoblotting demonstrated high levels of p50 with undetectable amounts observed in the adjacent normal liver counterparts. Further characterization revealed that p50 is a monomeric polypeptide with a neutral pI (6.5-7.2) and appears not to be glycosylated. The cellular localization was determined by direct antibody binding to intact cells, immunoprecipitation of 125I-labeled cell surface proteins, and Western immunoblotting of subcellular fractions. p50 was found on the cell surface as well as in the cytoplasm. In vitro monoclonal antibody binding studies indicate that the protein is expressed in all human malignant cells (n = 34) tested thus far regardless of the embryonic tissue of origin and the degree of differentiation. p50 was present at very low levels in normal tissues with the notable exception of high expression in adrenal glands. The protein is conserved in mammalian evolution since a similar protein was also found in bovine adrenals. The molecular characteristics and the pattern of expression of p50 indicate that this normal adrenal protein is associated with the transformed phenotype.
Adrenal Glands↗
Organization and structure of the Qa genes of the major histocompatibility complex of the C3H mouse: implications for Qa function and class I evolution.
We have determined the structure and organization of the entire Qa family of class I genes from the major histocompatibility complex of the C3H mouse. Restriction maps of overlapping lambda and cosmid clones reveal that there are only five Qak genes: Q1k, Q2k, Q4k, Q10k and a Q5/9 hybrid, presumably generated by unequal homologous recombination. The resulting deletion of Q6-Q9 is consistent with the Qa-2null phenotype of this mouse strain. We have sequenced the Qak genes, and predict that each may encode a class I molecule with a structure comparable with that proposed for the transplantation antigens. Furthermore, these Qa products should be able to bind peptides and interact with appropriate T-cell receptors. Interestingly, in comparing Qak and H-2k sequences, we find limited evidence of interlocus gene conversion between Qa and H-2 loci, suggesting that the Qa genes are not likely to serve as a reservoir of genetic information for the generation of H-2 diversity within this haplotype.
Amino Acid Sequence↗
Human chorionic gonadotropin and free subunits' serum levels in patients with partial and complete hydatidiform moles.
Serum levels of hCG and its free subunits were measured in patients with partial and complete hydatidiform moles and in women with normal 10-week pregnancies. whereas complete moles had higher levels of percent-free beta-hCG than partial moles (2.4 versus 1.0; P less than or equal to .005), partial moles had higher levels of percent-free alpha-hCG than complete moles (0.85 versus 0.17; P less than or equal to .005). Normal 10-week pregnancies had lower levels of both percent-free beta-hCG and percent-free alpha-hCG than partial moles (0.40 versus 1.0, P less than or equal to .005 and 0.27 versus 0.85, P less than or equal to .005, respectively). Percent-free beta-hCG and beta-hCG levels did not distinguish which patients with complete mole were more likely to develop persistent post-molar tumor. The trophoblastic cells in complete and partial moles differ significantly in the manner in which they secrete the free subunits of hCG.
Chorionic Gonadotropin↗
Human granulocyte activity against moxalactam-induced filamentous forms of Pseudomonas aeruginosa.
The purpose of this investigation was to study the kinetics of human granulocyte (polymorphonuclear leukocyte) phagocytosis and bactericidal activity against beta-lactam antibiotic (moxalactam)-induced filamentous bacterial forms of Pseudomonas aeruginosa. Ultrastructural observations of rod and filamentous forms of P. aeruginosa and their interaction with polymorphonuclear leukocytes are presented. Growth of P. aeruginosa 1348A in the presence of 4 micrograms of moxalactam per ml (one-fourth the MIC) resulted in filamentous forms. Phagocytosis of 75Se-radiolabeled filaments was more efficient than that of rods during the first 20 min of the assay; subsequently, phagocytosis of both forms was equal. The polymorphonuclear leukocyte bactericidal activities against both forms, which were standardized to equal bacterial particle and viable-cell counts, were equivalent. Considering the greater size and mass of filaments compared with those of rods, we concluded that filaments are more susceptible to both phagocytosis and killing than are bacillary forms.
Blood Bactericidal Activity↗
Maternal drug histories and congenital malformations: limb reduction defects and oral clefts.
In a case control study, prescription data were examined for the three months before the last menstrual period and for the first trimester of pregnancy in (a) 115 mothers of children with limb reduction defects, (b) 676 mothers of children with oral cleft, and (c) an equal number of control mothers of normal babies from the same doctor's practice for each case. In the limb reduction study, the study mothers were prescribed more drugs generally although this did not reach statistical significance, nor were there significant differences between study and control mothers for individual groups of drugs. In the oral cleft study, significantly more drugs were prescribed to study mothers in the three months before the last menstrual period, and a similar trend, which did not reach statistical significance, was observed in the first trimester. Anticonvulsant drugs were prescribed significantly more frequently to study mothers during the whole period of the study. A significant association was also demonstrated between oral contraceptives taken in the three months before the last menstrual period and oral cleft, but doubt must remain concerning this relationship; the risk is not well understood and is likely to be nonspecific. A number of other significant associations were identified, although their importance in practice is uncertain in view of the confounding factors that may affect a study of this kind.
Abnormalities, Drug-Induced↗
The effects of anterior hypothalamic deafferentation on FSH-releasing activity in the intact female hamster.
To study the role of the anterior hypothalamic area (AHA) in the control of the estrous (E) rise of follicle stimulating hormone (FSH), female hamsters were subjected to anterior hypothalamic deafferentation (D) or sham deafferentation (S) on 1500 h of proestrus (P). Serum levels of FSH and luteinizing hormone (LH) were measured by radioimmunoassay and FSH and LH releasing activities measured by bioassay in the anterior (AH) and medial basal hypothalamus (MBH) at several time periods during P and E. D did not affect serum levels of LH, whereas there was an attenuation of FSH levels during P and E. D caused an increase in FSH releasing activity in the AH within 1 h, while LH releasing activity was elevated 8 h after D. In animals with D, LH releasing activity in the MBH was elevated during P and was similar to controls during E. FSH releasing activity in the MBH increased during early E and dropped precipitously by 1400 h of E. Collectively, these data demonstrate dichotomous changes in FSH and LH releasing activities and provide further evidence for dual control mechanisms for these two gonadotropins.
Animals↗