Predictors of perceived control among African American women in Detroit: exploring empowerment as a multilevel construct.

Efforts to enhance empowerment toward the aim of improved health require an understanding of factors that contribute to perceived control at multiple levels, as a dimension of empowerment. In this article, the authors examine hypothesized predictors of perceived control at multiple levels among urban, African American women. Variables that predict perceived control include greater participation in change-related action; level of activity within respondents' most important organizations; and attempts made by those organizations to influence public officials, businesses, and other groups. Results suggest that (1) perceived control is a context-specific, multilevel construct; (2) citizen participation is an important factor in control and influence at multiple levels; and (3) organizations that are involved within neighborhoods and in the broader community can help to increase control and influence at multiple levels in marginalized communities. Implications for health education practice and research are discussed.     

Tag-72, CA 19.9 and CEA as Tumor Markers in Gastric Cancer

Serum levels of CEA, CA 19.9 and TAG-72 were measured in 79 patients with active gastric cancer, 47 with treated gastric cancer and no clinical evidence of the disease and 33 with benign gastric disease. In the patients with active gastric cancer TAG-72 was increased in 47%, CA 19.9 in 46% and CEA in 33%. The sensitivity of these markers was related to the stage of the disease, although upon comparison of stages I—II and III-IV significant difference was observed only for TAG-72. The combined use of two of the markers increased the sensitivity compared with the use of only one. The results suggest that the combination of TAG-72 and CA 19.9 may be useful in the post surgical management of patients with gastric cancer.     

Nasal Correction in Binder's Syndrome: The Evolution of a Treatment Plan

Maxillofacial dysplasia, or Binder's Syndrome is a challenge for the surgeon. The evolution of a surgical treatment plan has led to improved facial contour and patient self-image. We studied 27 patients with maxillonasal dysplasia of variable degrees, both on a short- and long-term basis. In some patients, surgical treatment began as early as 3 years of age, while others were treated as teenagers or young adults. Surgical options included cartilaginous onlay grafts to the pyriform area, nasal dorsal grafts (linear or L-strut in design), and columellar strut grafts. Le Fort osteotomies were reserved for those patients with Class III malocclusion (15% in this series). The overall goals were to augment skeletal deficiencies of the midface and begin the soft tissue expansion process as early as possible. From our long-term follow-ups (up to 15 years) it has become apparent that surgical treatment should begin early. This leads to improved self-image by the child's preschool years, taking advantage from their youthful skin elasticity. In the young patient, sequential lengthening procedures of the dorsum and columella are beneficial. Paranasal and midfacial augmentation is reserved until midfacial growth is near complete when the patient is in their midteenage years.     

Effects of smokeless tobacco on chemically transformed hamster oral keratinocytes: role of angiotensin I-converting enzyme

The purpose of this study was to determine whether exposureof chemically transformed golden Syrian hamster oral epidermoidcarcinoma cell (HCPC-1) cultures to smokeless tobacco extract(STE) is associated with a decrease in specific angiotensinI-converting enzyme (ACE) activity and whether this decreasepotentiates bradykinin-induced cell growth. We found that STEinduced a significant concentration- and time-dependent decreasein ACE activity in cultured HCPC-1 cells (P <0.05). STE alonehad no significant effect on cell number. Bradykinin alone induceda slight, but significant, increase in cell number (P <0.05).These effects were signific potentiated by STE (P <0.01).We conclude that STE potentiates bradykinin-induced HCPC-1 cellgrowth, in part by attenuating specific ACE activity in thesecells.     

Management of the perineal wound following abdominoperineal resection: prospective study of three methods.

A prospective study was made of three procedures for treating the perineal wound and presacral cavity in 102 patients undergoing abdominoperineal excision for cancer of the rectum: (1) packing of the presacral space after suture of the pelvic peritoneum; (2) suture of the pelvic peritoneum and perineal wound, leaving two drains through the perineum; and (3) no suture of the pelvic peritoneum, and primary closure of the perineal wound, leaving drains through the abdomen for physiological saline irrigation. The parameters analysed were incidence of infection, primary healing of the perineum, extraperineal complications and mean hospital stay. Primary healing of the perineum was best with method 3, and overall incidence of infection highest with method 2. There were no differences between the methods with regard to extraperineal complications. Hospital stay was shortest with method 3.     

Primary Sj?gren's syndrome in men. Clinical, serologic, and immunogenetic features

Although primary Sj?gren's syndrome is a common rheumatic disorder in women, it is not well recognized in men. This study represents the first report of the clinical, serologic, and immunogenetic features of a group of 36 men with primary Sj?gren's syndrome, which are contrasted with those of a group of 69 women with primary Sj?gren's syndrome. The majority of male patients had extraglandular involvement including articular (78 percent), neurologic (39 percent), inflammatory vascular (25 percent), and lymphoproliferative disorders (17 percent). Although men were at the same risk for the development of extraglandular complications, there were significant serologic and immunogenetic differences. In sharp contrast to women with Sj?gren's syndrome, men with Sj?gren's syndrome were seronegative with respect to the presence of serum rheumatoid factor (p = 0.008) and antibodies to Ro(SS-A) (p = 0.016). The supertypic specificity, MT2 (DRw52), as in women, was strongly associated with primary Sj?gren's syndrome in men when compared with race-matched control subjects (p = 0.0015). In men, however, the frequency of HLA-B8 and HLA-DR3, the most common DR locus specificity observed in women, was not statistically different from that observed in the normal control group.     

Combination chemotherapy of dacarbazine and fotemustine in disseminated malignant melanoma

Summary A total of 70 patients presenting with a disseminated malignant melanoma were entered into a multicentric study of combination chemotherapy using dacarbazine and fotemustine. In all, 63 patients were evaluable, 31.8% of whom had previously received cytotoxic chemotherapy. The protocol consisted of induction treatment with a weekly infusion of 100 mg/m² fotemustine on days 1 and 8 and a daily infusion of 250 mg/m² dacarbazine on days 15/18 followed by a 4- to 5-week rest period. Responding and stabilized patients were given maintenance treatment comprising fotemustine (100 mg/m², day 1) and dacarbazine (250 mg/m², days 2/5) every 3 weeks. The response rate was 33.3% (9 complete responses (CRs) and 12 partial responses (PRs)) and was outstanding among pretreated patients (34.9%). Responses were also documented in cerebral (28.6%), visceral (23.1%) and nonvisceral (43.3%) metastatic sites. Toxicity was mainly hematologic (22.2%, grade III/IV leukopenia; 20.3%, grade III/IV thrombocytopenia) and was acceptable. These results are encouraging in terms of the antitumor activity against nonvisceral metastases (43.3%) and the percentage of CRs obtained (23.3%), and they confirm the activity of fotemustine in cerebral metastatic sites.Other investigators involved in this trial included B. AUDHUY, CHR Louis Pasteur, Colmar; A. BERNADOU, Hôtel Dieu, Paris; J. J. BONERANDI, Hôpital Ste Marguerite; F. DANIEL, Hôpital St Joseph. Paris; P. FARGEOT, Centre Georges François Leelerc. Dijon; Pr KALIS, Hôpital Sébastopol, Reims; B. LABEILLE, Hôpital Sud, Amiens; P. LAURET, Centre Henri Becquerel, Rouen; P. LTTOUX, Hôtel Dieu, Nantes; G. LORETTE, Hôpital Trousseau, Chambray les Tours: R. METZ, Centre Alexis Vautrin, Vandoeuvre les Nancy; M. MOUSSEAU, CHR de la Tronche, Grenoble; J. L. VERRET, CHR, Angers, France