Caring for adults with mental retardation: survey of family practice residency program directors

In their core curriculum guidelines, the Society of Teachers of Family Medicine has recognized the importance of training family physicians in caring for persons with mental retardation. We mailed surveys to all family practice residency directors in the United States, questioning them about experiences and methods used to teach residents about health care needs of adults with mental retardation and the importance of this education. We found that 84% of programs provide residents with one or more experiences, and 60% instruct residents in this area. Most directors ranked this education as very important or important. There was no relationship between type or age of residency program and likelihood that residents were educated about mental retardation. The importance of this education is discussed.     

Differential cellular expression of isoforms of inositol 1,4,5-triphosphate receptors in neurons and glia in brain

Inositol 1,4,5-trisphosphate receptors (IP3R) are mediators of second messenger-induced intracellular calcium release. Three isoforms are known to be expressed in brain, but their regional distributions and cellular localizations are little known. In order to better understand the roles of IP3 receptor isoforms in brain function, a first step is to define their distributions. We have used affinity-purified antibodies directed against peptides unique to each isoform to determine their sites of expression in rat brain. Type 1 IP3R (IP3R1) is dramatically enriched in Purkinje neurons in cerebellum and neurons in other regions, consistent with previous studies. By contrast, IP3R2 is only detected in glia, whereas IP3R3 is predominantly neuronal, with little detected in glia. IP3R3 is enriched in neuropil, especially in neuronal terminals (which often contain large dense core vesicles) in limbic and basal forebrain regions including olfactory tubercle, central nucleus of the amygdala, and bed nucleus of the stria terminalis. In addition, IP3R1 and IP3R3 have clearly distinct time courses of expression in developing brains. These data suggest separate roles for inositol 1,4,5-trisphosphate receptor isoforms in development, and for glial and neuronal function. The IP3R3 may be involved in regulation of neurotransmitter or neuropeptide release in terminals within specific nuclei of the basal forebrain and limbic system.     

Cardiovascular effects of acute and chronic cocaine administration in pregnant and nonpregnant rabbits.

The effects of cocaine administration on cardiovascular parameters were studied in anesthetized nonpregnant and pregnant rabbits with no prior exposure to cocaine and in pregnant rabbits repeatedly administered cocaine (4 mg/kg, bid, iv) for 15-20 days prior to the experiment. Rabbits were instrumented to determine the effects of cocaine on blood pressure, heart rate, and organ blood flows. Administration of the 1 and 2 mg/kg doses of cocaine increased blood pressure and decreased heart rate in both pregnant and nonpregnant rabbits. In contrast, the 4 mg/kg dose of cocaine caused reductions in both blood pressure and heart rate. Cocaine (1, 2, and 4 mg/kg, iv) also caused dose-dependent reductions in organ blood flows. Interestingly, cocaine did not affect uterine blood flow in the nonpregnant rabbits, whereas uterine and placental flows were markedly reduced in both groups of pregnant rabbits. Chronic treatment with cocaine caused a significant increase in the basal blood flow to the placenta and spleen, and a more precipitous decrease in blood flow in both organs in response to an acute injection of cocaine. The chronically treated rabbits also had a greater incidence of cardiac arrhythmias in response to an acute injection of cocaine (4 mg/kg, iv). Rabbits that received repeated administrations of cocaine experienced more prolonged reductions in blood flow than rabbits with no prior exposure to cocaine. These studies show that cocaine has marked effects on organ blood flows and that pregnancy and repeated prior administrations of cocaine can enhance these effects.     

Children in single-father families in demographic perspective

The purpose of this article is to examine single-parent families headed by fathers. "We use specially constructed child files from the 1960-1990 Public Use Microdata Samples data from the Census of Population to address two general questions: (a) To what extent has both the likelihood and the demographic characteristics of these families changed over time? (b) What are the consequences for children of living in different kinds of father-only families? We find that single-father families are comparatively rare, but increasing rapidly, especially since 1980. Increasingly, these families are formed by fathers who are young, never married, with low incomes, and fewer children. Analysis of the 1990 data reveals wide diversity in living arrangements among children in single-father families. Furthermore, the social capital of children's fathers, the availability of adults, and children's economic well-being vary markedly across these types of families."     

Planned and unplanned postoperative admissions to critical care for mechanical ventilation

Purpose

To determine which factors influence the clinician in choosing critical care admission and postoperative ventilation, we prospectively examined the incidence, timing, causes, and risk factors for admission to critical care for postoperative ventilation within 48 hr of a surgical procedure (excluding cardiac and neurosurgical).

Methods

Patients were categorized as: admission planned preoperatively; admission unplanned and identified in the OR (Operating Room) or PACU (Post Anaesthetic Care Unit); and admission unplanned, identified after PACU discharge. Rates of admission by category for those with specific preoperative and intraoperative characteristics were compared to those without the characteristics to determine risk factors for admission (P < 0.01).

Results

Only 329 of 15,059 cases (2.2%) had a critical care admission. Of these, 288 were planned, 31 identified in the OR or PACU, and 10 after PACU discharge. A respiratory aetiology was the reason for admission in 75% of unplanned cases. Preoperatively, age ≥ 60 yr and common systemic illnesses (cardiac, renal, pulmonary) were markers for planned admission, but only positive HIV status was a risk factor for unplanned admission. The two main physiological features which identified all critical care admissions were haemoglobin oxygen saturation <90% (preoperatively breathing room air and intraoperatively) and tachycardia during the operative period. Six of ten of the unplanned after PACU discharge patients underwent bronchoscopy with a neurolept analgesic technique.

Conclusion

Postoperative admissions to a critical care unit, both planned and unplanned, are uncommon. This study has identified haemoglobin oxygen desaturation during the perioperative period and intraoperative tachycardia as important markers for all admissions to critical care.     

Molecular diagnosis of exocrine pancreatic cancer using a percutaneous technique

Background: The K-ras oncogene is activated by point mutations at codon 12 in most patients with exocrine pancreatic cancer. Mutant-enriched polymerase chain reaction (PCR) amplification can enhance the detection of mutated K-ras. This technique was applied to patients undergoing percutaneous fine-needle aspiration (FNA) biopsy of suspect pancreatic lesions. Methods: Twenty-five patients underwent percutaneous FNA of the pancreas for cytologic and molecular analysis. After preparing cytologic smears, the 22-gauge needle and syringe used for FNA were rinsed in RPMI-1640. The specimen was centrifuged, and DNA was extracted from the supernatant and subjected to mutant-enriched PCR using appropriate mismatched primers that introduce a BstNI restriction endonuclease cleavage site at codon 12 of wild-type, but not mutant, K-ras. After digestion with BstNI, the DNA was reamplified. To increase assay sensitivity, the final five PCR cycles were completed incorporating 5 μCi of (α-32P)dCTP. The DNA was then redigested and subjected to gel electrophoresis and autoradiography. Results: The median amount of DNA retrieved per specimen was 3.33 μg. Mutant K-ras was detected as a band of 143 bps; residual wild-type DNA was seen as a 114-bp fragment. Twenty-one of 25 specimens demonstrated mutated K-ras DNA. Two patients with nondiagnostic cytology results had mutated K-ras DNA; adenocarcinoma of pancreatic origin was confirmed in both cases after pancreatectomy. Conclusion: The molecular diagnosis of pancreatic cancer through identification of mutations in K-ras can be readily performed on specimens obtained by percutaneous FNA. As aggressive multimodality management of this disease becomes more common, pretreatment analysis of molecular determinants may have greater clinical significance. Presented at the 48th Cancer Symposium of The Society of Surgical Oncology, Boston, Massachusetts, March 23–26, 1995.     

3H-Apomorphine interactions with dopamine receptors in calf brain

3H-apomorphine binds to membranes from areas of the corpus striatum and limbic system of calf brain saturable and with a drug specificity indicating that it labels dopamine receptors. In terms of drug specificity, log-logit displacement curve slopes and number of binding sites, 3H-apomorphine interacts with receptors in a manner more like 3H-dopamine than 3H-haloperidol. These properties of 3H-apomorphine binding are those of an apparently "pure" agonist in contrast to the partial agonist effects of apomorphine upon the dopamine-sensitive adenylate cyclase.     

The use of a computer to select optimized conditions for high-performance liquid chromatography separation.

Computer simulation allows the convenient prediction and optimization of HPLC separation as a function of various separation conditions. The use of retention and bandwidth relationships that have been validated for a broad range of chromatographic systems minimizes the number of experimental runs needed, especially for the new technique of restricted multi-parameter optimization. The chromatographer is free to use these procedures in a trial-and-error mode, or alternatively use can be made of resolution maps and other data summaries. "Gridding" experiments, based on the automated collection of chromatographic data, can be used to supplement predictions obtained from computer simulation.