The changes in blood platelet numbers, size, adhesiveness, and response to adenosine diphosphate have been followed for about a month after major operations performed on 19 patients. The well established increase in numbers was confirmed and reached a maximum of rather less than double the normal numbers in the third week. It was accompanied by a reduction of platelet size from 8.3mu(3) to 7.2mu(3), and by an increased responsiveness shown in all the tests employed. These abnormalities were preceded by an initial change in the reverse direction from that obtaining at the peak of the response. In this series the bead method proved superior, as a means of delineating the postoperative platelet response, to the rotating bulb method in tests of timing, proportional changes, and of discrimination.

Adenine Nucleotides↗

PubMedDate not supplied

Opening pathways to cancer screening for Vietnamese-American women: lay health workers hold a key.

PURPOSE: We describe a controlled trial of a community outreach intervention to promote recognition, receipt, and screening-interval maintenance of clinical breast examinations (CBE), mammograms, and Pap smears among Vietnamese-American women. METHODS: Over a 3-year period, indigenous lay health workers conducted small-group sessions of Vietnamese women in a low-income district of San Francisco, California. Women in Sacramento, California, served as controls. Lay workers conducted 56 sessions on general prevention, 86 on cervical cancer, and 90 on breast cancer. Surveys of 306 to 373 women were conducted in the study communities in 1992 and 1996. RESULTS: In the intervention community, recognition of screening tests increased significantly between pre- and postintervention surveys: CBE, 50 to 85%; mammography, 59 to 79%; and Pap smear, 22 to 78% (P = 0.001 for all). Receipt of screening tests also increased significantly: CBE, 44 to 70% (P = 0.001); mammography, 54 to 69% (P = 0.006); and Pap smear, 46 to 66% (P = 0.001). Best-fitting logistic regression models, adjusting for preintervention rates and significant covariates, also showed statistically significant odds ratios for the intervention effect (P < 0.0001). CONCLUSIONS: Trained Vietnamese lay health workers significantly increased Vietnamese women's recognition, receipt, and maintenance of breast and cervical cancer screening tests.

Adolescent↗

PubMedDate not supplied

Safe laparoscopic cholecystectomy in a community setting, N = 762.

Laparoscopic cholecystectomy (LC) can be introduced into a community with morbidity and mortality rates equal to that of open cholecystectomy. The entire general surgical community of Greensboro, NC, learned the technique of LC on animal models prior to offering this innovation to the community. Over the ensuing 12 months, they served as surgeons or assistant surgeons to each other on 762 LCs with morbidity and mortality rates comparable to open cholecystectomy. This retrospective study examined the first 1 year of experience beginning 8/13/90. This work represents all of the LCs performed in Greensboro, and all of the surgeons participated in this review. All of the surgeries were done with an electrocautery and utilized a 0 degree forward-viewing scope. Cases were performed at two hospitals with a surgeon as both operator and assistant, and no effort was made to exclude high-risk or elderly patients from this procedure. Patients averaged 50 years of age and ranged from 14 to 96 years. Static cholangiograms were performed in 27% of patients. Conversion to open cholecystectomy was seen in 4.8%. There were two cardiac deaths (0.26%) and significant complications were seen in 3.4%. Seven patients required reoperations. There were no major common bile duct injuries. This retrospective review indicates that this new procedure can be introduced into a community setting by novice laparoscopic surgeons acting both as operators and assistant with a morbidity and mortality rate comparable to that reported for open cholecystectomy.

Cholangiography↗

PubMedDate not supplied

Supersensitivity to opioid analgesics following chronic opioid antagonist treatment: relationship to receptor selectivity.

The effect of chronic opioid antagonist treatment on the analgesic potency of six opioid agonists was compared to changes in opioid receptor density and the selectivity of each agonist for mu (DAMGO), delta (DPDPE) and kappa (U69,593) opioid receptors. Mice were implanted SC with a 15-mg naltrexone or placebo pellet for 8 days. The pellets were removed and 24 h later, mice were sacrificed and binding studies were conducted, or mice were tested in analgesia (tail-flick) dose-response studies. All six analgesics acted as full agonists for both placebo and naltrexone-treated mice. Naltrexone increased the analgesic potency of methadone, etorphine, fentanyl, meperidine, and oxycodone by 1.9-3.2-fold. The analgesic potency of propoxyphene was not increased significantly (1.3-fold). In saturation binding studies in brain homogenate, naltrexone increased the Bmax of mu, delta, and kappa opioid receptors by 86, 43, and 33%, respectively, without altering Kd. Competition binding studies for each receptor type were conducted in brains from untreated mice, and KIs were determined for each agonist. All agonists had greatest selectivity toward mu compared with delta and kappa receptors. There did not appear to be an obvious relationship between receptor selectivity and the magnitude of supersensitivity. These studies indicate that supersensitivity occurs for a broad range of opioid analgesics following chronic opioid antagonist treatment in the mouse. However, the selectivity of these agonists for mu, delta, and kappa receptors does not appear to correlate with differences in supersensitivity.

Analgesics↗

PubMedDate not supplied

Screening of insect cell lines for the production of recombinant proteins and infectious virus in the baculovirus expression system.

Eight cell lines derived from the insects Spodoptera frugiperda, Trichoplusia ni, Mamestra brassicae, and Estigmene acrea were evaluated for recombinant beta-galactosidase and infectious virus production following infection with the baculovirus Autographa californica multiple nuclear polyhedrosis virus (AcMNPV). Production was assessed on a specific (per cell and per microgram of uninfected cellular protein) and on a volumetric (per milliliter) basis. Cell density was found to be an important factor in comparing the cell lines due to a density-dependent inhibition of specific protein and virus production that appeared to result from cell-cell contact. After infection of cells at low-density specific beta-galactosidase production per cell would drop between 3- and 6-fold in five of the eight cell lines when plated on tissue culture plates at near-confluent and confluent cell densities. The cell lines Sf 21 and Sf 9 were least sensitive to cell density. After accounting for cell density effects and differences in cell size, two cell lines, BTI Tn 5B1-4 and BTI TnM, were identified that were superior to the other cell lines, including Sf 21 and Sf 9, in beta-galactosidase production. Optimal volumetric and specific beta-galactosidase production from Tn 5B1-4 and TnM cells was 2-fold and 5-fold higher, respectively, in both cell lines than the optimal production from Sf 9 or Sf 21 cells. The Tn 5B1-4 cell line also had the highest viability of all the cell lines at 3 days postinfection and could be adapted to serum-free media.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMedDate not supplied

Drug abuse treatment on demand in San Francisco: preliminary findings.

This article reports on a process and capacity evaluation of San Francisco's Treatment on Demand Initiative, which was launched in 1997 to increase availability of publicly-funded substance abuse treatment. For the process evaluation, data from public documents, interviews with community key informants, and newspaper articles were analyzed. For the capacity evaluation, budget documents and admissions data for publicly-funded substance abuse treatment in San Francisco for fiscal years 1995-1998 were analyzed. Results from the process evaluation document the development of the community-oriented Treatment on Demand Planning Council, and its efforts to not only expand treatment, but to create a continuum of services to address the needs of San Francisco's richly diverse communities, to provide service enhancements, and to prioritize service needs. Process evaluation results also highlight the complexities of implementing treatment on demand, including the difficulty of opening new programs. Results from the capacity evaluation indicate that the San Francisco budget supporting publicly-funded treatment increased from $32 million to $45.2 million over four years. During the same period, the number of persons entering the system in a single year increased by 18%, and the number of admissions in a single year increased by 15%. Implications of these findings are discussed.

Female↗

PubMedDate not supplied

Detection of human papillomavirus L1 protein in condylomata acuminata from various anatomical sites.

BACKGROUND AND OBJECTIVES: Though human papillomavirus (HPV) DNA can be detected in the majority of condylomata acuminata, the major capsid protein of HPV (L1 protein) can be detected in only 10% to 50% of lesions in immunohistochemical assays. GOAL OF STUDY: To evaluate the association between anatomic location of genital HPV infections and the ability to detect HPV L1 protein. METHODS: Condylomata acuminata from 49 male and 51 female patients were evaluated for L1 protein by immunohistochemistry. Thirty of these lesions were vulvar; 20 were cervical; 1 was vaginal; 45 were penile; and 4 were perianal. A quantitative analysis of L1-positive nuclei in the lesions was performed. RESULTS: L1 protein was detected in 20 (20%) of all lesions. L1 protein was detected in seven (35%) of the cervical lesions compared to nine (12%) of exophytic condylomata acuminata of males and females (P = 0.038). A statistically significant difference was noted between cervical and exophytic condylomata acuminata lesions (46.6 vs. 7.8) (P = 0.0006). No association between oral contraceptive use and L1 protein detection was found. CONCLUSIONS: The major capsid protein of HPV can be detected in condylomata acuminata of the uterine cervix more often, and in higher quantities, than in lesions of the vulva or penis. Further studies are needed to assess the effects of sex hormones and the anatomic location of the infection as they relate to transmission of HPV.

Biopsy↗

PubMedDate not supplied

Profile of hypertensives as a determinant of long-term antihypertensive medication needs.

The experience of 110 hypertensives who participated in a worksite stepped-care treatment program has been examined to draw a patient profile at entry that would determine medication needs on a long-term basis. Patients entered untreated with a blood pressure (BP) level of greater than or equal to 160 mm Hg systolic and/or greater than or equal to 95 mm HG diastolic (DBP) and had a minimum follow-up of 1 year. Treatment was initiated with diuretics, and additional drugs were added as necessary to achieve BP control. Patients were divided into three groups according to initial DBP levels: Group A (33 patients, greater than or equal to 105 mm Hg), Group B (43 patients, 95-104 mm Hg), and Group C (34 patients, less than 95 mm Hg). Using a life table method, we analyzed the therapeutic experience of these patients to obtain 5-year cumulative rates of adding a second drug to diuretics. Within the first 2 years of treatment, the cumulative rates were: 64% in Group A, 33% in Group B, and 23% in Group C. In all three groups the rates after the second year remained stable. This stepped-care approach resulted in BP control (less than 160/95) which ranged from 78% in the first year to 96% in the fifth year. Findings suggest that initial DBP level and age are principal factors in determining medication needs. Furthermore, at higher DBP levels, younger nonwhite and younger white males are most likely to require a second drug within the first year of treatment. The need for a second drug is apparent within the first 2 years.

Adult↗

PubMedDate not supplied

Reduction of cardiovascular disease events by worksite hypertension treatment.

A retrospective cohort study of hypertensive employees to evaluate the impact of worksite antihypertensive treatment (WST) on cardiovascular disease (CVD) over 8 1/2 years is reported. In a union-sponsored screening from August 1973 to February 1974, 604 hypertensives (greater than or equal to 160 and/or 95 mm Hg, or on medication) were identified. Of these, standardized criteria were met by 344, of whom 150 chose WST and 194 referred care (RC). The study groups were similar in age and sex composition. Union hospitalization and death records through 1982 revealed that CVD rates were fewer in WST than RC (3.0 vs 5.4/100 person-years; p less than 0.01). By contrast, nonCVD rates were similar (8.1 vs 9.6). All-cause mortality rate in WST (0.89) was significantly (p less than 0.05) lower than that in RC (1.81), as was the standard mortality ratio (55.1), based on U.S. mortality in 1978. CVD mortality was also lower (0.48 vs 1.10; NS). Persons with an initial blood pressure (BP) less than 160/95 mm Hg had CVD event rates that were low and similar in WST and RC (3.6 vs 3.5). However, among those with elevated BP at entry, WST subjects fared significantly better than RC (2.8 vs 6.1; p less than 0.001). Furthermore, in WST, previously treated patients with elevated BP at screening experienced one-third the CVD morbidity of their counterparts in RC (3.1 vs 10.8; p less than 0.01). These results extend previous evidence that WST is an effective method to achieve BP control and demonstrate that this approach to the management of hypertension alters health outcomes favorably and significantly.

Age Factors↗

PubMedDate not supplied

Improving outpatient diabetes management through a collaboration of six competing, capitated Medicare managed care plans.

This report addresses diabetes care in the managed care setting and improvement in care brought about by collaboration between 6 Medicare managed care plans (MCPs) and a Peer Review Organization (PRO). The objective was to improve the quality of care of outpatient diabetes patients provided by primary care physicians through the mutual collaboration of 6 Medicare managed care plans and a Medicare Peer Review Organization. The design involved pre-post intervention trial based on 2 random samples, a baseline sample drawn in 1995 and a remeasurement sample drawn in 1996. Medical records of patients in both samples were reviewed by the PRO to determine provision of 14 quality indicator services over a 1-year period. The setting was 6 Arizona Medicare managed care plans comprising approximately 40% of the Arizona Medicare population. Two random samples were drawn from type 2 diabetes patients continuously enrolled in the same managed care plan for at least 1 year. The intervention was comparative feedback of baseline data by the PRO, enabling each plan to compare itself to any other plan on any or all indicators. Each plan developed and implemented its own intervention in response to the 1995 baseline results. The main outcome measures were mean HbA1c, the proportion of HbA1c values below 8%, and positive change in provision of 14 quality indicator services. At postintervention remeasurement, mean HbA1c values fell from 8.9 +/- 2.2 to 7.9% +/- 2.1, and the proportion of patients with HbA1c values below 8.0% rose from 40% to 61.6%. The proportion of the 14 indicator services provided to patients rose from 35% to 55%. The mean number of physician office visits fell 13% and the number of services provided per visit doubled. We conclude that improving the process of care improves glycemic control. Better outpatient diabetes management in competing, capitated managed care plans is an attainable goal when mediated through a neutral third party such as a PRO.

Ambulatory Care↗

PubMedDate not supplied

Angioscopic valvulotomy: evaluation of a new miniaturized prototype.

This study compares valvulotomy performed by a new experimental instrument delivered through the angioscope with the standard technique used in the in situ arterial bypass procedure. Eighteen mongrel dogs (approximately 20 kg) were anesthetized and both femoral veins were exposed from the groin to the knee. A 2.5-mm-external-diameter angioscope was passed through the medial saphenous vein to just below the proximal superficial femoral vein valve. Under direct vision, an experimental valvulotome passed through one of the angioscope ports cut the valve leaflets. In the contralateral limb, a Mills valvulotome was inserted in the same fashion and blindly cut the valve. Operative time was recorded and difficulties were noted. Bilateral ascending lower limb venography, animal sacrifice, and removal of the vein segment containing the area of previous valvulotomy for gross and histologic study were performed immediately (n = 3), and at 2 (n = 3), 7 (n = 3), 21 (n = 4), and 42 (n = 5) days after valvulotomy. In each case, both techniques had cut the valve leaflets by visual and histologic evaluation. It took significantly longer to perform the operative procedure with the angioscope (8.0 +/- 3.7 min) than with the Mills valvulotome (0.8 +/- 0.4 min) (P less than or equal to .001, Student's ttest). There was no difference in the patency of the venous system by venographic study but evaluation for a histologically normal venous system was more common with the Mills technique. The angioscopic technique demonstrated 8 of 18 samples to be histologically normal versus 14 of 18 by the Mills technique (P less than or equal to .05, chi-square test). Both techniques are effective in valve leaflet incision. The new angioscope device is more technically demanding (e.g., operative time) and may be more traumatic (e.g., histologic study). However, a gross estimation of luminal damage (venography) does not find the angioscopic method more thrombogenic. The new angioscopically directed device for venous valvulotomy does function effectively. However, adaptation to the in situ bypass technique to replace present angioscopic methods or blind valvulotomy methods requires an appraisal of just what degree of intraluminal trauma is permissible before the risks outweigh the possible benefits.

Analysis of Variance↗