Intracoronary Radiation Post PTCA Prevents Late Arterial Constriction

Vascular constriction post PTCA is a major component in the mechanism of restenosis following intervention. Ionizing radiation demonstrated reduction of neointima formation after injury in animal models and lowered the restenosis rates in pilot clinical studies. To determine the effect of intracoronary radiation therapy on vascular remodeling, angiograms from two radiation trials were analyzed by QCA methods. Patients in these trials had de novo lesions and were treated with balloon angioplasty followed by either beta or gamma radiation. All patients were studied angiographically at 6 months; patients with total occlusion at the treated artery were excluded from the analysis. In the gamma trial, 192-Iridium was utilized in 14 patients (15 lesions) with doses between 20-25 Gy. In the beta trial, 90-Sr/Y was utilized in 17 patients (17 lesions) with doses between 12-16 Gy. The QCA analysis from these studies demonstrated negative late loss and late loss index at six months for patients from the beta (-0.02 ± 0.3) and the gamma (-0.19 ± 0. 3) study. The effect of positive remodeling was maintained at 24 months, -0.16 ± 0.4 in the gamma group. Larger MLD at follow-up compared to the immediate post MLD were demonstrated in 50% of the patients from both studies. Thus, intracoronary radiation resulted in lower late loss and late loss index rates than previously reported following balloon angioplasty alone suggesting a positive vascular remodeling effect of intracoronary radiation.     

Stability of Artemisinin in Aqueous Environments: Impact on its Cytotoxic Action to Ehrlich Ascites Tumour Cells

We have recently shown artemisinin to be cytotoxic against Ehrlich ascites tumour cells. The aim of this study was to investigate the stability of this compound in the aqueous environment of the in-vitro Ehrlich ascites tumour cell system (RPMI 1640 cell culture medium supplemented with 10% foetal bovine serum (RPMI/FBS) with reference to its cytotoxic action. Literature data show that artemisinin can react with Fe²⁺ yielding reactive intermediates leaving artemisinin G as a major end-product. The current study showed that only excess addition of Fe²⁺ to artemisinin in distilled water, phosphate-buffered saline (PBS) and RPMI/FBS and incubation for 24 h led to degradation of artemisinin and yielded artemisinin G. If Fe²⁺ was not added results from HPLC analysis were indicative of complete recovery of artemisinin from distilled water and RPMI/FBS, with or without cells, at 37°C for at least 24 h. In addition, incubation of artemisinin in RPMI/FBS with or without cells at 37°C for 24 h before cytotoxicity assay did not change its cytotoxic action. On the basis of these results, we suggest that cytotoxicity to tumour cells was caused by unchanged artemisinin. This is not so for the antimalarial activity of artemisinin and derivatives, for which the presence of a pool of (haem) Fe²⁺ is a prerequisite resulting in free radicals or electrophilic intermediates or both.     

Change and Stability in Quantity and Frequency of Alcohol Use Among Aging Males: a 19–year follow-up study

This report describes prospective data from a 19–year follow-up of a general household sample of San Francisco (California) white males as these men moved towards ‘old age’. Only minor changes were noted in frequency of use while important decreases were discovered in the heavier quantity levels upon follow-up. Men who changed consumption patterns over time were approximately twice as likely to decrease as increase at follow-up. These findings are directly relevant to the interpretation of the consistent cross-sectional finding of decrease in heavy drinking and associated alcohol-related problems among older age strata when these strata are compared to younger cohorts.     

The triangular treatment paradigm in dual‐diagnosis clients with a mental illness

Research evidence suggests that a large number of individuals with substance misuse problems also have accompanying psychopathology. Some of those individuals diagnosed with schizophrenia may warrant a dual‐diagnosis. The clinical area of psychiatric ‘dual diagnosis' – that is, serious mental illness associated with substance misuse – is often linked to the ‘revolving door’ admissions of individuals with this complex comorbidity picture. Often, there is limited sharing of information and cooperation between statutory agencies with reference to this highly vulnerable client group. The shortfall in appropriate clinical response to this client group has been highlighted by previous researchers. This article looks at the role of the specialist dual‐diagnosis worker in North Wales and how the appointee to this role has been able to facilitate the seamless transition of these individuals through the ‘system’ of mental health care. This process has been facilitated by the development of an Integrated Pathway of Care, which has been devised by the authors and called the Triangular Treatment Paradigm.     

Monitoring health in the war-affected areas of the former Yugoslavia, 1992-1993

In October 1992 the World Health Organization (WHO) set up ahealth monitoring programme in the former Yugoslavia to obtaininformation on communicable disease upon which to base decisionsabout medical aid requirements. This paper covers the firstyear of the programme (October 1992–October 1993) anddetails the steps taken to set it up. Information was soughtfrom personal contacts, ‘ad hoc’ sources (UnitedNations agencies and non-governmental organizations) and thehealth authorities of the regions of former Yugoslavia. An attemptwas made to establish a sentinel monitoring system to provideroutine data to allow health predictions to be made. A bulletinwas produced to disseminate surveillance results and healthadvice. The system obtained sufficient data (mostly from ‘adhoc’ sources) for WHO to take informed decisions aboutmedical aid but the sentinel system was not established successfully.     

WHAT IS ADOLESCENT ALCOHOL MISUSE IN THE UNITED STATES ACCORDING TO THE EXPERTS?

A self-administered 16-page questionnaire eliciting opinionsabout cut-off points for alcohol misuse was mailed to ten experts(seven men, three women) in alcohol research and treatment.These experts were selected to be representative of alcoholinvestigators from universities and research institutions fromacross the United States of America. Experts were asked to provideinput with respect to frequency-quantity of alcohol use, high-riskdrinking, and negative consequences items. Results revealedconsiderable variability in opinion about the different indicatorsof alcohol misuse. Exact agreement between different alcohol-useexperts was rare. Reliability estimates revealed highest agreementfor indicators of high-risk drinking, followed by negative consequences,and then frequency-quantity. Comments from the experts indicatedthat most felt that frequency and quantity should be consideredtogether rather than separately. As expected, recommended cut-offpoints for alcohol misuse varied by age of the drinker, withmore leeway given to older than younger adolescents.     

Cardiac Involvement in Cystic Fibrosis Revealed by a Ventricular Arrhythmia

Cardiac involvement in cystic fibrosis (CF) is characterized by acute cardiac failure in the infant with myocardial fibrosis found on pathological examination. In the older child with chronic pulmonary disease, cor pulmonale tends to predominate the clinical picture. We report the case of an adolescent with CF presenting with ventricular arrhythmia. Cardiac scan, repeated echocardiograms and Hotter monitoring were suggestive of an infiltrative process. We propose this case to be similar to those of CF in infants with cardiac involvement.