A clinic-based mammography intervention targeting inner-city women

OBJECTIVE: The objective was to evaluate the effect of a clinic-based intervention program on mammography use by inner-city women. DESIGN: A randomized controlled trial employing firm system methodology was conducted. SETTING: The study setting was a general internal medicine clinic in the university-affiliated county hospital serving metropolitan Seattle. PARTICIPANTS: Women aged 50 to 74 years with at least one routine clinic appointment (when they were due for mammography) during the study period were enrolled in the trial (n = 314). INTERVENTIONS: The intervention program emphasized nursing involvement and included physician education, provider prompts, use of audiovisual and printed patient education materials, transportation assistance in the form of bus passes, preappointment telephone or postcard reminders, and rescheduling assistance. Control firm women received usual care. MEASUREMENTS AND MAIN RESULTS: Mammography completion within 8 weeks of clinic visits was significantly higher among intervention (49%) than control (22%) firm women (p < .001). These effects persisted after adjustment for potential confounding by age, race, medical insurance coverage, and previous mammography experience at the hospital (odds ratio 3.5; 95% confidence interval 1.9, 6.5). The intervention effect was modified by type of insurance coverage as well as prior mammography history. Process evaluation indicated that bus passes and rescheduling efforts did not contribute to the observed increases in screening participation. CONCLUSIONS: A clinic-based program incorporating physician education, provider prompts, patient education materials, and appointment reminders and emphasizing nursing involvement can facilitate adherence to breast cancer screening guidelines among inner-city women.     

Antibody-mediated enhancement of respiratory syncytial virus infection in two monocyte/macrophage cell lines

Monoclonal antibodies (MAbs) specific for two surface glycoproteins of respiratory syncytial virus (RSV) were found to enhance RSV infection in two macrophagelike cell lines (P388D1 and THP-1). MAbs to an irrelevant antigen (pneumococcal polysaccharide) and to the nucleocapsid of RSV did not enhance infection. Blocking either the Fc segment of the monoclonal antibody of the Fc receptor on the cells diminished the enhancement, suggesting that this phenomenon involves attachment of the monoclonal antibody to the virus followed by attachment of the Fc of this complex to the Fc receptor on the cells. These data indicate that antibody-mediated enhancement of RSV infection can occur in vitro in macrophages. This enhancement may contribute to the pathogenesis of RSV bronchiolitis and the more severe RSV disease seen in recipients of formalin-inactivated RSV vaccine.     

Changes in the concentration of 17 alpha,20 alpha-dihydroxypregn-4-en-3-one during pregnancy, labor, and delivery and the effect of dexamethasone treatment during the third trimester of pregnancy

To study whether an alteration of placental steroid metabolism occurs during human pregnancy similar to that in the ewe, we measured the concentration of 17 alpha,20 alpha-dihydroxypregn-4-en-3-one (17,20 alpha-OHP) in peripheral plasma. As the pregnant ewe nears term, the utero-ovarian venous concentrations of 17,20 alpha-OHP increase, suggesting induction of placental 17 alpha-hydroxylase. The mean plasma concentration of 17,20 alpha-OHP measured by RIA in normal menstruating women was 1.1 +/- 0.12 (+/- SE) ng/ml. Similar values were found in plasma from ovariectomized women. In the first and second trimesters of pregnancy, the plasma values of 17,20 alpha-OHP were not significantly different from those in the nonpregnant women, while in the third trimester, the mean plasma concentration was significantly increased (mean +/- SE, 2.6 +/- 0.3 ng/ml). The plasma concentration of 17,20 alpha-OHP was studied in 15 women in late pregnancy, during labor, at delivery, and postpartum. The concentration increased during labor as delivery approached and reached a maximum at the time of delivery, ranging from 4.1-11.2 ng/ml, followed by a significant decrease within 1-4 h postpartum. The mean (+/- SE) 17,20 alpha-OHP concentrations in the venous and arterial cord blood were 8.7 +/- 1.6 and 5.8 +/- 2.0 ng/ml, respectively. To study the effect of increased circulating level of corticosteroids on the serum concentration of progestins, 74 women with premature labor with or without premature rupture of membranes were treated with either placebo or 4 im injections of dexamethasone phosphate (5 mg each) at 12-h intervals. Blood samples were drawn at 0, 14, 26, and 46 h, approximately 2 h after each dexamethasone dose. Plasma progesterone, 17 alpha-hydroxyprogesterone (17-OHP), and 17,20 alpha-OHP values at zero time were 140 +/- 15.8 (+/- SE; n = 21), 7.8 +/- 1.5 ng/ml (n = 16), and 2.3 +/- 0.3 ng/ml (n = 20), respectively. In patients treated with dexamethasone, the plasma progesterone values tended to increase at 14, 20, and 46 h, but 17-OHP and 17,20 alpha-OHP values decreased significantly compared to levels in placebo-treated patients. In conclusion, the concentration of plasma 17,20 alpha-OHP increased during the third trimester of pregnancy, and the increment continued through labor and delivery. During antenatal dexamethasone administration, progesterone in the maternal circulation tended to increase, while 17-OHP and 17,20 alpha-OHP decreased significantly. In the human, in contrast to the ewe, dexamethasone treatment in the third trimester does not appear to stimulate placental 17 alpha-hydroxylase activity.     

Supraventricular tachycardia dependent upon accessory pathways in the absence of ventricular preexcitation

Paroxysmal supraventricular tachycardia is a common disorder of cardiac rhythm, generally thought to be due to reentry within the atrioventrlcular (A-V) node. The possibility that this disorder may be a manifestation of the Wolff-Parkinson-White syndrome should always be considered, but this etiology is usually rejected if the electrocardiogram in sinus rhythm falls to demonstrate a delta wave (i.e., ventricular preexcitatlon). Several recent reports have demonstrated that an accessory A-V pathway may conduct impulses only in the retrograde or ventriculo-atrial direction. Hence, reentrant tachycardia based on a mechanism identical to that observed in patients with classic Wolff-Parkinson-White syndrome may occur, and the electrocardiogram in sinus rhythm fail to show a delta wave. This report describes 11 patients who presented with paroxysmal supraventricular tachycardia without QRS changes in sinus rhythm that suggested the Wolff-Parkinson-White syndrome. Electrophysiologic studies demonstrated that an accessory pathway participated in the mechanism of the tachycardia. Eight of these 11 patients were successfully treated by surgical interruption of either the accessory pathway or the bundle of His. Accessory pathways are not rare among patients with paroxysmal supraventricular tachycardia; and it follows that this variant of the Wolff-ParkinsonWhite syndrome is more common than would be suspected if the Wolff-Parkinson-White syndrome is considered only when delta waves are observed on the electrocardiogram.     

Rapid interaction of prolactin with mouse mammary gland explants.

Exposure of mouse mammary gland explants to prolactin at 0 degrees C, for periods as brief as 10 seconds, caused a stimulation of labeled uridine incorporation into RNA during a subsequent incubation for 4 h at 37 degrees C. Furthermore, a 2-h wash of the prolactin-exposed explants in media at 0 degrees C did not attenuate the hormonal effect. A similar exposure of explants to insulin, followed by a 2-h wash at 0 degrees C, caused the abolition of the insulin stimulation of labeled uridine incorporation into RNA. The results suggest that there is a rapid and relatively stable interaction of prolactin with the mammary gland, while the interaction of insulin with this tissue would appear to be less stable.     

Atrial natriuretic peptide response to cardioversion of atrial flutter and fibrillation and role of associated heart failure.

Plasma atrial natriuretic peptide (ANP) concentrations were measured before and 1 hour after cardioversion in 40 patients (27 with atrial flutter and 13 with atrial fibrillation) admitted for elective cardioversion. Fourteen (11 with atrial flutter and 3 with atrial fibrillation) had clinical evidence of congestive heart failure (CHF). Conversion to sinus rhythm was successful in 39 patients. The mean ANP concentration in the entire group decreased after cardioversion from 38 +/- 4 to 17 +/- 2 pmol/liter (p less than 0.001). In the subgroup with CHF, the ANP level, which was not significantly higher than that in the group without CHF, decreased from 47 +/- 8 to 19 +/- 3 pmol/liter (p less than 0.01). Neither mode of cardioversion (spontaneous 1, pharmacologic 2 and direct-current countershock 36) nor associated CHF influenced ANP response to cardioversion. One patient with atrial flutter and "failed cardioversion" had unchanged ANP level. The decrease after cardioversion in ANP concentration correlated with its control level (r = 0.88, p less than 0.001) but not with the decrease in heart rate. The ANP level in patients with atrial fibrillation was 45 +/- 9 vs 38 +/- 5 pmol/liter in those with atrial flutter (difference not significant). Arrhythmia duration, left atrial size, and ventricular rate or arterial blood pressure did not correlate with ANP concentration in any subgroup. It is concluded that (1) the ANP level is elevated comparably in patients with both atrial flutter and fibrillation regardless of the presence or absence of CHF; and (2) the level decreases, independent of the mode of cardioversion or presence of CHF, promptly after successful cardioversion.     

Local airway heat and water vapour losses.

A previously developed time-dependent mathematical model of the heat and water vapour transport in the human respiratory tract for mouth breathing (Daviskas et al., J. Appl. Physiol. 69:362-372, 1990) was applied to calculate the local quantities of heat and water transfer. The results of the heat and water losses agreed with experimental data. The contribution of each airway to the conditioning of inspired air was found to depend on the inspired air conditions and the pattern of breathing as expected. The greater proportion of the total heat and water loss was calculated to occur within the upper airways. However, below the pharynx, the rate of water loss during hyperpnea was calculated at a much faster rate than in the resting state. The rate at which water is returned to the airways may not be adequate to keep the periciliary fluid isotonic. These findings support the proposal that the intrathoracic airways could become significantly dehydrated during hyperpnea. The use of calculated local heat and water transfer rates may help to predict the site of stimuli to exercise-induced asthma.     

Nutritional therapy for peripheral arterial disease: a double-blind, placebo-controlled, randomized trial of HeartBar

We investigated the clinical effects of a food bar enriched with L-arginine and a combination of other nutrients known to enhance the activity of endothelium-derived nitric oxide (EDNO) in individuals with claudication from atherosclerotic peripheral arterial disease. The study was a 2-week, double-blind, placebo-controlled trial of subjects randomized to three groups (two active bars, one active and one placebo bar, and two placebo bars per day) followed by an 8-week open-label period. Subjects (n=41) were outpatient volunteers with intermittent claudication. Pain-free and total walking distances were measured by variable-grade, treadmill exercise testing. Quality of life was assessed using the Medical Outcome Survey (SF-36). After 2 weeks of treatment, the pain-free walking distance increased 66% while the total walking distance increased 23% in the group taking two active bars/day. The general and emotional/social functioning components of the SF-36 also improved. These effects were not observed in the one active bar/day and placebo groups. The effects were maintained after 10 weeks and, in addition, an improvement in walking distance was observed in the group taking one active bar. These findings reveal that use of a nutrient bar designed to enhance EDNO activity improves pain-free and total walking distance as well as quality of life in individuals with intermittent claudication.     

Total colonic ischemia

The involvement of the entire colon in an ischemic process is unusual because of the dual source of blood supply to the large bowel. Three cases of total ischemic colitis are presented. A precipitating cause to account for the distribution of ischemia was identified in each patient.