Serum carcinoembryonic antigen correlates with severity of idiopathic pulmonary fibrosis

Background and objective: Idiopathic pulmonary fibrosis (IPF) is the commonest idiopathic interstitial pneumonia and carries a poor prognosis. Epidemiological evidence suggests that patients with IPF have an increased risk of developing lung cancer. Carcinoembryonic antigen (CEA) has a close association with epithelial malignancy. The aim of this study was to evaluate serum CEA concentrations in patients with IPF and to perform correlation with pulmonary function. Methods: Serum CEA concentrations were measured by two‐site sequential chemiluminescent immunometric assay in 41 non‐smoking patients with IPF. Patients with a history of gastrointestinal tract malignancy or other disorder known to be associated with raised serum CEA were excluded. Results: A total of 41 patients were evaluated. The mean (±standard deviation) age of patients was 73 ± 7 years. The mean (±standard deviation) forced vital capacity was 88 ± 20% of predicted, and the mean (±standard deviation) diffusing factor for carbon monoxide (DLco) was 52 ± 19% of predicted. Twenty‐one (51%) patients had a serum CEA concentration higher than upper limit of the normal range (0–5 ng/mL). CEA concentration was significantly negatively correlated with lung function (P = 0.005; R² = 0.20 for forced vital capacity and P = 0.006; R² = 0.20 for DLco). Raised CEA level also correlated significantly with the extent of fibrosis. A lung biopsy specimen from a patient with IPF demonstrated strong staining for CEA in metaplastic epithelium lining the honeycombed cysts and respiratory bronchioles. Conclusions: Serum CEA concentration is elevated in approximately half of patients with IPF and is correlated with disease severity. Immunohistochemical staining reveals that CEA localizes to metaplastic epithelium lining honeycombed bronchioles.     

Plasma and Erythrocyte Zinc Concentrations and their Relationship to Dietary Zinc Intake and Zinc Supplementation During Pregnancy in Low-Income African-American Women

Objective To evaluate the effects of usual dietary intake of zinc and of zinc supplementation during pregnancy on plasma and erythrocyte zinc concentrations.Design A randomized, double-blind, placebo-controlled trial.Subjects Low-income African-American women (n=580) assigned randomly to groups at 19 weeks of gestation.Intervention A daily dose of zinc (25 mg) or a placebo until delivery.Main outcome measures Plasma, erythrocyte, and dietary zinc levels.Statistical analyses Multiple regression and repeated measures analysis of variance.Results In both the placebo and the supplemented groups, when all subjects were grouped by usual dietary zinc intake above or below the median (12 mg/day), results were the same: Women with high dietary zinc intake had higher erythrocyte zinc levels at the time of randomization and at all subsequent measurements during pregnancy than those who had low dietary zinc intake (P≤.06; difference not significant for zinc-supplemented group); no difference was observed for plasma zinc levels. On the other hand, when the subjects were stratified at the median by total daily zinc intake (usual dietary zinc + 25 mg zinc supplement) during pregnancy, a significant difference in plasma zinc levels (P<.005) was found between women with high total zinc intake (mean=38 mg/day) and low total intake (mean=13 mg/day) at 26, 32, and 38 weeks of gestation; however, no such differences were found in erythrocyte zinc levels.Applications These results should help dietitians and other health professionals better understand the expected changes in plasma and erythrocyte zinc levels during pregnancy, and the relationship between dietary and supplemental zinc and zinc nutriture. J Am Diet Assoc. 1997;97:1296-1274.     

Electronic Templates versus Dictation for the Completion of Mohs Micrographic Surgery Operative Notes

BACKGROUND: Operative notes can be generated electronically by manual input of the entire note, free-form oral dictation, or using either an electronic template or a template for dictation. There are few studies that have directly compared these modalities in terms of speed, accuracy, and completeness. OBJECTIVE: The objective was to determine whether electronic templates are more efficient and reduce errors compared to free-form oral dictation for the completion of Mohs micrographic surgery operative notes. METHODS: Operative notes for 110 consecutive Mohs micrographic surgery cases were completed either by oral dictation or by electronic template. The time to dictate or complete the template was recorded for each note. Notes were subsequently edited, recording the number and type of errors as well as the time required to edit each note. RESULTS: Compared with dictation, operative notes completed with the electronic template had fewer errors (5.8% vs. 81%), took less time to complete (175.5 seconds vs. 240.0 seconds), took less time to review and edit (41.6 seconds vs. 201.1 seconds), and were completed and signed in a more timely fashion (0.115 days vs. 20.7 days). CONCLUSION: Electronic templates are a more accurate and rapid method compared to free-form oral dictation for the completion of Mohs micrographic surgery operative notes and have the advantage of being immediately available to review and sign.     

Inappropriate Sensing of Atrial Stimuli in Patients with Third-Generation Defibrillators and DDD Pacemakers

Although the problem of ICD sensing of paced ventricular stimuli has been resolved by incorporation of VVI pacing into current ICDs, many patients require separate DDD pacemakers. We report a problematic PM-ICD interaction: the inability to prevent sensing of paced atrial stimuli (atrial sensing) leading to double-counting in DDD-PM-requiring patients with transvenous (TV) ICDs with aggressive autogain sensing (CPI Ventak® PRxII or III). Four of eight patients receiving both transvenous DDD PMs and ICDs (CPI Endotak® lead, at the RV apex), had atrial sensing, leading to double counting, despite intraoperative testing of multiple atrial locations with an active fixation lead. Five patients had a PRxlI/III ICD, four with atrial sensing (80%), and three a PRx without atrial sensing. Patients with atrial sensing were not distinguished by any clinical or device related variable. In patients with atrial sensing (all with heart block), the PM was programmed to VDD mode. No patient has received inappropriate therapy or failed to sense VP in follow-up. In many patients with TV ICDs who require DDD pacing, no atrial position can be found without ICD sensing of atrial stimuli. While in patients with heart block this problem can be circumvented by programming to the VDD mode, in patients with sinus incompetence it may only be resolved by the combination ICD-DDD PM, currently in development.     

Sex Differences in Alcohol Consumption and its Associated Morbidity in Young Civil Servants

An examination of alcohol consumption and its relationship with minor psychiatric morbidity, general practitioner consultations, sickness absence and labour turnover in a cohort of young white collar employees revealed substantial sex differences in the quantity of alcohol consumed in the previous week, and also in the degree to which consumption of more than 30 units/week was associated with increased levels of psychological symptoms, general practitioner consultations sickness absence and labour turnover. These findings underline the need for urgent revaluation of what is a safe quantity of alcohol to consume for either sex.     

Eosinophilic interleukin 5 (IL-5) transgenic mice: eosinophil activity and impaired clearance of Schistosoma mansoni

Eosinophilia is a feature common to many invasive helminth infections and eosinophils are often considered to be effector cells in immunity to helminths. This study examined the possible influence of constituitive eosinophilia on the clearance of Schistosoma mansoni infections in mice. Eosinophils from interleukin-5 transgenic mice exhibit normal ultrastructure and function with regard to phagocytosis and killing of bacteria and responses to chemotactic stimuli. IL-5 transgenics and non-transgenic littermates were immunized once or four (hyperimmunization) times with irradiated cercariae of S. mansoni . Animals were challenged percutaneously with unirradiated cercariae one month after their last exposure to irradiated parasites. One month after challenge transgenic animals, whether unimmunized, vaccinated or hypervaccinated, carried significantly more liver-stage parasites than non-transgenic animals. These results suggest that although eosinophils from IL-5 transgenic mice are functional for a number of key parameters, large numbers of eosinophils and/or high levels of IL-5 may in some way impair clearance of S. mansoni. A re-evaluation of the roles of eosinophils and IL-5 in infections with this and other parasites may therefore be warranted .     

National survey of syringe exchange schemes in England

This report gives information from an England wide survey of syringe exchange carried out in early 1989. A postal questionnaire was sent to 74 agencies, responses received from 65 (88%), of which 55 were agencies operating syringe exchanges. The development of syringe exchanges has been marked by lack of central coordination, supervision and direction, allowing for local autonomy sensitivity to local conditions and a resulting diversity of practices. Four service models were identified: schemes run by drag agencies; phannacybased schemes; specialist stand-alone schemes; and schemes based in non-drug agencies. The average number of different clients per week was 21 and it is estimated that they distributed about one million syringes in the year 1988/89. Pharmacy based schemes presented fewer barriers in terms of access but offered limited services on site, while drug agency schemes presented more barriers in terms of access, but offered more services. The significance of these differences is related to the aims of syringe exchange. In a public health orientation, ease of access to sterile injecting equipment would be the priority and the question of individual help in other areas less important. From a drug problems orientation, the ability to offer clients more services to respond to their wider needs would be a priority. It is estimated that by the end of 1989 there were approximately 120 syringe exchange schemes in England.