Exercise as a treatment for hypertension in low-socioeconomic-status black children

Low-socioeconomic-status (SES) Black children have a higher mean blood pressure than most other groups. The antihypertensive effects of a 12-week aerobic exercise program were examined on 11 low-SES Black children, ages 8-12, who had blood pressure above the 95th percentile. A multiple baseline across three groups of children with baseline and exercise conditions was conducted. After the introduction of the exercise program, there were significant decreases in diastolic and systolic blood pressure. Cardiovascular fitness improved concurrently. The results suggest that vigorous exercise can decrease the blood pressure of low-SES hypertensive Black children.     

Three novel PROC gene lesions causing protein C deficiency

Hallam PJ, Mannucci P, Tripodi A, Bevan D, Laursen B, Tengborn L, Wacey A, Cooper DN. Three novel PROC gene lesions causing protein C deficiency. Clin Genet 1998: 54: 231–233. 0 Munksgaard, 1998
Missense mutations. three of them novel (Am210→Val, Asn248→ Ile, Ah355→Val), were found in the protein c ( PROC ) genes of 7 patients with inherited protein C deficiency associated with venous thrombosis. Comparison with the phenotypic effects of mutations in the analogous residues of factor IX causing hdernophilia B and the use of molecular modelling has provided explanations as to how these lesions might alter either the structure, function or secretion of the protein C molecules encoded.     

In vitro and in vivo immunolabeling of sporozoites,schizonts, and sexual stages ofEimeria acervulina andE. tenella by a species-and stage-cross-reactive monoclonal antibody

A cross-reactive monoclonal antibody (mAb), designated 1205, was used to study redistribution, parasitophorous vacuole (PV) incorporation, and in situ antigen production during the intracellular parasite development ofEimeria acervulina andE. tenella. Western-blot analysis of sporozoite preparations showed that the mAb recognized antigenic bands at 55 and 80 kDa. Indirect immunofluorescent antibody (IFA) labeling of sporozoites produced an internal dot pattern. Immunogold electron microscopy (IM) showed labeling of dense granules within sporozoites. The IFA pattern changed to a general-internal label in immature schizonts followed by a surface-tip pattern in mature merozoites both in vitro and in vivo. IM of the asexual stages revealed the same labeling pattern for the in vivo development of both species, and labeling of rhoptries was seen. In vitro, the PV membrane together with amorphous material within the PV was labeled by IFA during schizont development forE. tenella. No IM labeling of either the PV membrane or material within the PV was observed. Sexual stages seen in vivo for both species had the general-internal IFA pattern.     

Cesarean section

Although the cesarean section rate has increased steadily for the past 12 years, further increase seems unlikely since the indications for performing the operation are already broadly defined. Most of the earlier indications will remain unchanged (eg, the presence of placenta previa and cephalopelvic disproportion). The trend toward vaginal delivery in perhaps 30% to 40% of breech births will probably have no material effect on the number of cesarean sections performed, and the present use of cesarean section for multiple pregnancy will probably continue. The two conditions under which cesarean section rates might become significantly lower are (1) automatic repeat cesarean section (which now accounts for more than 25% of all cesarean sections), a procedure which will probably decline as increasing numbers of such women have vaginal deliveries, and (2) a redefinition of the present midforceps classification, which will permit some of the easy midforceps deliveries from a low level to be performed without the legally abhorrent stigma of mid-forceps delivery. The value of prophylactic antibiotics for women predisposed to infection has now been proved, and further placebo studies to demonstrate this are not warranted. In the past, "type and match 2 units" was a routine prelude to cesarean section, and for every unit of blood transfused to cesarean section patients, some 25 units were cross-matched and held in (unnecessary) readiness. This formula is gradually giving way to type and screen, eliminating countless crossmatches. Because of possible harmful fetal effects, preoperative fluid loading, a necessary part of conduction anesthesia, is changing from the customary 5% glucose to the use of fluids containing no glucose. It has been suggested that conduction anesthesia may not offer unlimited time for cesarean section, as used to be thought. Apgar scores are lower if the time from uterine incision to delivery is longer than three minutes, a diminution that may be a function of the anesthesia or may reflect difficulty in delivery. Cesarean section mortality is much lower than it was in former years, but one may expect from one to two deaths per 1,000 operations. Overall, the maternal mortality from cesarean section per se is probably from three to five times higher than that of vaginal delivery (in one series, 11.5 times higher than vaginal delivery). The incidence of mild, transient respiratory signs in the newborn is higher after cesarean than after vaginal delivery, and the incidence of respiratory distress syndrome is also slightly higher.(ABSTRACT TRUNCATED AT 400 WORDS)     

Long-term follow-up for locally advanced and inflammatory breast cancer patients treated with multimodality therapy.

PURPOSE: To determine long-term event-free (EFS) and overall survival (OS) for patients with stage III breast cancer treated with combined-modality therapy. PATIENTS AND METHODS: Between 1980 and 1988, 107 patients with stage III breast cancer were prospectively enrolled for study at the National Cancer Institute and stratified by whether or not they had features of inflammatory breast cancer (IBC). Patients were treated to best response with cyclophosphamide, doxorubicin, methotrexate, fluorouracil, leucovorin, and hormonal synchronization with conjugated estrogens and tamoxifen. Patients with pathologic complete response received definitive radiotherapy to the breast and axilla, whereas patients with residual disease underwent mastectomy, lymph node dissection, and radiotherapy. All patients underwent six additional cycles of adjuvant chemotherapy. RESULTS: OS and EFS were obtained with a median live patient follow-up time of 16.8 years. The 46 IBC patients had a median OS of 3.8 years and EFS of 2.3 years, compared with 12.2 and 9.0 years, respectively, in stage IIIA breast cancer patients. Fifteen-year OS survival was 20% for IBC versus 50% for stage IIIA patients and 23% for stage IIIB non-IBC. Pathologic response was not associated with improved survival for stage IIIA or IBC patients. Presence of dermal lymphatic invasion did not change the probability of survival in clinical IBC patients. CONCLUSION: Fifteen-year follow-up of stage IIIA and inflammatory breast cancer is rarely reported; IBC patients have a poor long-term outlook.     

The clinical and pathophysiologic implications of pain, ST abnormalities, and scintigraphic changes induced during dipyridamole infusion: their relationships to the peripheral hemodynamic response

In order to determine their significance during dipyridamole perfusion scintigraphy, symptomatic, ECG, and scintigraphic findings were related to each other, to the hemodynamic response, and to angiographic findings in 73 consecutive patients having coronary angiography within 3 months of scintigraphy. The group having induced "cardiac" pain differed from the group without induced pain only in their higher incidence of induced ischemic ST changes, the "marked" hemodynamic response, and their lower incidence of an "absent" hemodynamic response (all p less than 0.01). Induced ST depression was found only in patients with coronary disease. In this population, dipyridamole-induced pain was a moderately specific marker and induced ST abnormalities a more highly specific marker for coronary disease. However, both were insensitive for coronary disease diagnosis. If induced pain or ST abnormalities in the presence of significant coronary disease were accepted as indicators of ischemia, then scintigraphic abnormalities appeared to be produced by dipyridamole in roughly equal incidence by ischemic and nonischemic mechanisms. Induced ischemia related frequently to an exaggerated hypotensive response with no change in double product, suggesting its cause to be an induced increase in myocardial oxygen demand. Dipyridamole-induced image defects were noted even in the absence of a peripheral hemodynamic response. This indicates that the peripheral response does not always correlate with its central coronary effect and an absent peripheral hemodynamic response does not necessarily invalidate scintigraphic results.     

Extended presence of antide (Nal-Lys GnRH antagonist) in circulation: prolonged duration of gonadotropin inhibition may derive from antide binding to serum proteins

Previous data from this laboratory revealed a rapid (-12h) and unexpectedly long (-30 days) inhibition of pituitary gonadotropin secretion after a single injection of Antide (Nal-Lys GnRH antagonist) in ovariectomized (OVX) monkeys. Although the apparent mechanism of action of Antide is competitive occupancy of GnRH receptors, the etiology of the prolonged action is unknown. Here, we report development of a radioreceptor assay to measure circulating Antide levels to determine the mechanism(s) of its long duration of action. Five long-term OVX monkeys were injected with Antide (3.0 mg/kg). Blood samples were collected daily for 30 days, and thereafter on alternate days until day 60. Following sc or iv Antide injection, peripheral luteinizing hormone (LH) levels declined from 281 +/- 19 ng/ml to 29 +/- 3 ng/ml within one day (P less than 0.05). LH levels slowly recovered to pretreatment levels within 35 +/- 7 days. Peripheral Antide levels were 16,531 +/- 4,432 ng/ml within 15 minutes following iv injection, and 52 +/- 21 ng/ml at 1 day after sc Antide injection. Interestingly, thereafter clearance of Antide-from the peripheral circulation was very slow, with an apparent t1/2 (second phase) of 6.5 days following iv administration. Detectable Antide levels were present in the peripheral circulation for more than one month in all five monkeys. In a second experiment, incubation of 125I-Tyro Antide with OVX monkey serum resulted in binding of the labelled peptide to serum proteins and reduction of 125I-Tyro Antide binding to pituitary receptors. Following gel permeation chromatography, greater than 70% of the radioactivity was associated with a 66 kDa protein(s). In conclusion, the prolonged duration of gonadotropin inhibition by Antide seems to derive from the long circulatory half-life of this molecule. In turn, this extended action of Antide may be manifest, at least in part, by binding to serum protein(s) that serves as a built-in peripheral depot release mechanism.