A pilot study of home-based genetic testing completion rate in telegenetics cancer clinics in West Virginia Appalachia

Telegenetics has shifted some genetic testing performance to the patient's own home, with the patient collecting his/her own sample. Little is known regarding the rate of test completion of such home-based genetic testing. This study compared the completion rate of home-based genetic tests before and after a reminder system was implemented. In the pre-reminder group, we reviewed medical records for patients who were seen via telegenetics and agreed to complete genetic testing using an at-home test kit. In the reminder group, a prospective analysis of the genetic test completion rate was performed taking a clinical quality improvement approach where three reminders were provided for patients who had not submitted their at-home genetic testing. Our study included 94 patients' records: 46 pre-reminders and 48 reminders. The lab received 24 patient samples (52.2%) in the pre-reminder group. In the reminder group, 30 patients returned their kits (62.5%). Despite a higher percentage of patients completing their test in the reminder group, there was no statistically significant difference between the pre-reminder and reminder groups. The rate of test completion in our pilot test was statistically similar between the two groups, but the reminder group was trending toward a higher percent of completion which may be clinically meaningful.     

Factors Influencing the Growth in Knowledge of Trainees in General Practice

Objectives: The relation between the content of postgraduate training for general practice and the outcome in terms of the growth in knowledge of trainees was investigated. The training variables included were: (1) the number of patients seen per day, (2) the trainer, (3) the practice and (4) the theoretical curriculum.Methods: Subjects were 58 trainee-trainer pairs. Growth in knowledge was assessed by two written tests administered with eight months interval. Training variables were evaluated by means of questionnaires and logbook-registration. The correlation was explored between each of the training variables and the knowledge tests scores. To correct for interactional effects, a step-wise multiple regression analysis was performed with the second test as dependent variable and the first test as well as the training variables as independent variables.Results: Significant growth in knowledge was demonstrated. Non of all training variables investigated explained the variance in scores on the second test equally good or better than the scores on the entry test.Conclusions: The impact of the separate training-components on the growth in knowledge, remains unclear. We may speculate, that the sort of knowledge assessed with the written literature based true/false test is different from the sort of knowledge transferred during every day training: evidence based knowledge versus experience based knowledge. Equally valid is the conclusion that these findings fit into the theory that in adult learning the outcome is more learner than teacher dependent.This revised version was published online in September 2005 with corrections to the Cover Date.     

Relation between concentration of lead, zinc and lysozyme in placentas of women with intrauterine foetal growth retardation

Intrauterine foetal growth retardation (IUGR) implies increased risk of morbidity and mortality of the newborn. Aetiology of intrauterine retardation is probably multifactorial and may include maternal infection, malnutrition, placental dysfunction, hypertension, toxaemia, smoking, professional and environmental exposure. The work concentrates on the lead, zinc and lysozyme levels in blood and placental tissues of 50 females in the IUGR group and 43 females from a control group. Statistically significant differences in zinc and lead levels between the compared group were found. The IUGR group had lower zinc and higher lead levels. A significant negative correlation of zinc and lead levels was observed. We found a statistically significant relationship between lead levels in placental tissues and the age of the pregnant women. Higher age is associated with higher lead levels in placental tissue, whereas zinc levels decrease. In placental tissues of pregnant females of the IUGR group higher lysozyme levels were found. On the basis of the discussed results the authors recommend zinc supplementation during the pregnancy.     

Breast milk studies in the Bitterfeld district

Human milk samples were tested for pesticide residues (particularly chlorinated hydrocarbons) in 1996 in continuation of the environmental medical tests conducted in 1990 and 1993 in Bitterfeld county. Although the overall human milk contamination due to chlorinated hydrocarbons was reduced, there were still higher concentrations of DDT and beta-HCH detected compared to the concentrations found in what was formerly West Germany. The objective of this follow-up testing of 106 human milk samples was to observe overall trends as well as the specific effects of sanitary and environmental protection measures after three years. Sample preparation included fat extraction and chromatographic column studies. The extracts were analyzed by means of two different gas chromatography systems based on electron-catching detectors. Overall, the contamination was reduced compared to the years of 1990 and 1993. Contaminant concentrations did not exceed the "tolerable concentration" while using a safety factor of 10. However, few beta-HCH (2% of the samples), HCB (22%), total DDT (20%), and more than half of total PCB samples exceeded the "tolerable concentrations" while using a safety factor of 100. A major decrease in the average contamination was noticed for total PCB (63% decrease for 0.3 mg/kg of milk fat), beta-HCH (77% decrease for 0.056 mg/kg of milk fat), and HCB (57% decrease for 0.091 mg/kg of milk fat). The concentration of the heptachlorepoxide was even reduced to 1%. Whereas the DDT and DDD concentrations were also reduced compared to 1993 (83% decrease for 0.033 mg/kg of milk fat, and 84% decrease of 0.005 mg/kg of milk fat), the DDE concentration increased (32% increase for 0.755 mg/kg of milk fat). This can be explained by the decomposition of enzymes from DDT to DDE and the extremely high accumulation tendency of this metabolite. The results show that the contamination of women over time was influenced by two contrary factors. On one hand, the internal exposure increases with age; on the other hand lactation eliminates contaminants from the body of the mother. Comparison to other states' data shows that the results match the overall picture of the residue situation in Germany. Results of the environmental-medical investigations from 1996 demonstrate a predominant decrease of contamination with chlorinated hydrocarbons within the human body. This tendency was possibly influenced by two developments. The global usage of persistent chlorinated hydrocarbons was critically observed and regulated more strictly in recent years, which decreased their concentration tremendously. The other reason for the reduction of contamination by chlorinated hydrocarbons in the county of Bitterfeld could be the improving environmental situation in this region.     

The therapist's use of self and cultures in children's psychotherapy groups

This paper presents a model for understanding decisions that a therapist makes concerning the use of the self as a therapeutic tool in children's psychotherapy groups. The parameters within which a therapist uses self is directly related to the development of the group's culture. It is proposed that two complementary cultures develop within children's groups, one, indigenous peer culture, strictly of the children's making and the other, therapeutic group culture, created by the therapist in collaboration with group members. Having taken the time to learn a group's indigenous peer culture the therapist can use its metaphors to speak to the children in their own language; eventually it will be possible to engage them in collaboratively building a meaning system which is uniquely designed to address their psychotherapeutic needs. Initially, when indigenous peer culture is predominant, the therapist uses self more receptively in order to connect with the children through empathic immersion, holding intolerable affects and developmental time travel; as treatment progresses and a therapeutic group culture is slowly constructed, the therapist may use him/her self for more change directed interventions through role modeling, confrontation and self disclosure.Chief Psychologist and Coordinator, Children's Clinical Services, Brookline Community Mental Health Center and Instructor, Psychiatry (Psychology), Harvard Medical School and private practice in Brookline and Newton Massachusetts.     

Is a serotonergic mechanism involved in 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)-induced appetite suppression in the Sprague-Dawley rat?

The major cause of TCDD-induced death in rats is a progressive voluntary feed refusal which has been correlated with reduced gluconeogenesis. Since centrally administered TCDD does not cause death or decreased feed intake in rats, the ability of TCDD to suppress appetite via peripheral mechanisms acting on the central nervous system was examined in two experimental models. First, it was found that the feed intake of rats on scheduled feeding cycles was not decreased by blood transfused from rats with TCDD-induced appetite suppression (8 days after a lethal dose of TCDD, i.p.). In contrast, a similar transfusion from normal, satiated rats did reduce feed intake of recipient rats by approximately 40%, suggesting that TCDD-treated rats are not satiated but rather that they are not hungry. In the second study tryptophan (the amino acid precursor of the neurotransmitter serotonin) was measured in the plasma and tryptophan, serotonin, norepinephrine and dopamine in the hypothalamus as well as dopamine and its metabolites in the striatum 4, 8, and 16 days after TCDD dosage (125 g/kg, i.p.). Progressive time-dependent increases in tryptophan levels in plasma and brain were paralleled by increases in brain serotonin and 5-hydroxyindoleacetic acid (the primary metabolite of serotonin) in TCDD-treated rats. No changes were observed regarding the other biogenic amines. It is suggested based on these data and on substantial evidence from the published literature that a serotonergic mechanism may be involved in TCDD-induced feed intake reduction.     

Generalized amyloidosis from β2-microglobulin,with caecal perforation after long-term haemodialysis

Summary A 73-year-old man with chronic renal failure of undetermined aetiology had received haemodialysis for 12 years when he died of acute purulent peritonitis due to caecal perforation. Amyloid deposits detected in a cystic bone lesion in the left hip had caused a pathological fracture 17 days before death. At autopsy, extensive amyloid deposits were found in the osteoarticular system, in the cartilaginous surface and the capsular tissue of joints, ligaments, vertebral discs and bone. In addition, vascular amyloid deposits were diagnosed in the heart, kidneys, testes, lungs, skin and in the gastrointestinal tract. A special feature of this case were interstitial amyloid deposits forming a fine-meshed structure in the myocardium and plate-like deposits in the gastrointestinal tract. Immunohistochemically, all these deposits reacted strongly with antibody to human ₂-microglobulin but showed no reaction with antibodies to AA, Alambda, A-kappa and AF. The present case demonstrates that extra-osteoarticular manifestations of AB-amyloidosis can cause serious complications.     

Changes in blood flow and vasculature of the dog kidney undergoing normothermic and hypothermic ischaemia

Summary In 11 mongrel dogs both kidneys have been subjected to a 2 h ischaemic period. One kidney was cooled by perfusing the renal artery at 4°C while the contralateral normothermic kidney was clamped for 2 h. Studying the renal blood flow using the Xenon wash out technique, sequential renal scanning and angiography, marked differences between hypo- and normothermic ischaemia kidneys were observed. One or two hours following hypothermic perfusion a marked decrease of blood flow in the first compartment and vasoconstriction was evident, while within this period following normothermic ischaemia an enhanced renal blood flow was observed. After 24 h renal blood flow and renal function tested by ¹³¹I-Hippuran clearance returned to normal values. Angiographic studies corresponded to the preoperative findings. In contrast, normothermic ischaemia kidneys showed a decreased renal blood flow, impairment of kidney function in isotope studies and pathological angiographic changes.Supported by Deutsche Forschungsgemeinschaft     

Predictors of occult metastasis in clinical stage I nonseminoma: a systematic review.

PURPOSE: Patients with clinical stage I nonseminomatous testicular germ cell tumor should ideally receive adjuvant therapy only when they are at high risk for occult metastasis. We aimed to quantify the importance of predictors for occult metastasis by performing a systematic review of the relevant literature. In addition, we reviewed published multivariable models and risk-adapted treatment policies. PATIENTS AND METHODS: We identified 23 publications between 1979 and 2001, reporting a total of 2,587 patients. Twenty-nine percent of the patients (759 of 2,587 patients) had occult metastases, which was diagnosed either at retroperitoneal lymph node dissection (n = 193) or during follow-up (n = 566). Odds ratios (OR) were pooled using meta-analysis techniques. RESULTS: The presence of vascular invasion of the primary tumor cells had the strongest effect (OR, 5.2; 95% CI, 4.0 to 6.8). Immunohistochemical staining of the primary tumor cells with the MIB-1 monoclonal antibody showing proliferative activity was a promising predictor (OR, 4.7; 95% CI, 2.0 to 11). Intermediate effects were found for embryonal carcinoma in the primary tumor (OR, 2.9; 95% CI, 2.0 to 4.4) and a high pathologic stage of the tumor (OR, 2.6; 95% CI, 1.8 to 3.8). Size of the primary tumor and age of the patient had weaker though also statistically significant associations with occult metastasis. Until now, multivariable models often included vascular invasion and embryonal carcinoma with one or two weaker predictors. None of the published risk-adapted treatment policies included MIB-1 staining. CONCLUSION: Several strong predictors for occult metastasis were identified. A risk-adapted treatment policy should be developed that incorporates all relevant predictors so that adjuvant therapy is targeted better to those with occult metastases.