Content of the neurotoxins cycasin (methylazoxymethanol beta-D-glucoside) and BMAA (beta-N-methylamino-L-alanine) in cycad flour prepared by Guam Chamorros.

Exposure to cycad seed kernel is an etiologic factor for the western Pacific amyotrophic lateral sclerosis (ALS) and parkinsonism-dementia complex (PDC). Traditionally processed cycad flours (n = 17) obtained from Chamorro residents of Guam and the adjacent island of Rota at risk for neurodegenerative disease were extracted and analyzed by high-performance liquid chromatography for content of beta-N-methylamino-L-alanine (BMAA) and methyl-azoxymethanol beta-D-glucoside (cycasin). Cycasin (detection limit: picomole) was present in concentrations of 0.004 to 75.93 micrograms/g (mean, 12.45 +/- 5.0 micrograms/g), and levels of BMAA (detection limit: subpicomole) ranged from 0.00 to 18.39 micrograms/g (mean, 5.44 +/- 1.56 micrograms/g). On average, cycasin content was approximately 10 times higher than that of BMAA. The largest concentrations of cycasin were found in samples from villages with a high reported prevalence of ALS/PDC. Ingestion of cycad-derived food would result in estimated human exposure to milligram amounts of cycasin per day. The cytotoxic properties of cycasin merit consideration in relation to the etiology of western Pacific ALS/PDC.     

Recurrent postcoital lower-extremity streptococcal erythroderma in women. Streptococcal-sex syndrome

Two women with underlying distortion of their lower-body lymphatic systems from neoplasia and surgery or radiation therapy had recurrent episodes of lower-extremity erythroderma temporally associated with sexual intercourse. Both women had vaginal colonization with Streptococcus agalactiae (group B); one was shown to have recurrent bacteremia with this organism at the time of the episodes. Erythroderma developed in these women possibly because of seeding of S agalactiae in the vaginal soft tissues during coitus.     

Habitual physical activity and estradiol levels in women of reproductive age.

Variation in the risk of breast cancer observed among women and among populations may be explained by variation in lifetime exposure to estrogens. The suppressive effect of exercise on estradiol levels in women is well documented, but it is unknown whether habitual (i.e. typical daily) physical activity has a similar effect. Epidemiological data suggest that physical activity is one of the few modifiable factors capable of reducing the risk of breast cancer in women. We investigated whether variation in the amount of habitual activity corresponds to variation in estradiol levels in women of reproductive age. One hundred and thirty-nine regularly menstruating women 24-37 years of age collected daily saliva samples for one complete menstrual cycle and kept a daily log of physical activity. Saliva samples were analyzed for concentration of estradiol. We observed a negative relationship between habitual physical activity and salivary levels of estradiol. Mean estradiol was 21.1 pmol/l in the low, 17.9 pmol/l in the moderate and 16.6 pmol/l in the high activity group (all pairwise differences were statistically significant at P<0.009). A strong association exists between physical activity and levels of estradiol among women of reproductive age. A modern lifestyle, characterized by reduced physical activity, may therefore contribute to a rise in the levels of estradiol produced during menstrual cycles and thus to higher cumulative lifetime exposure to estradiol, resulting in a higher risk of breast cancer.     

Pelvic ring disruptions: effective classification system and treatment protocols

From January 1, 1985, to September 10, 1988, 210 consecutive patients with high-energy pelvic ring disruptions (exclusive of acetabular fractures) were admitted to a statewide referral center for adult multiple trauma. They were treated by one of four attending orthopaedic traumatologists per protocol as determined by their injury classification and hemodynamic status; the injury classification system was based on the vector of force involved and the quantification of disruption from that force, i.e., lateral compression, anteroposterior compression, vertical shear, and combined mechanical injury. Of the 210 patients, 162 had complete charts: 126 (78.0%) were admitted directly from the scene, 110 (67.9%) were injured in motor vehicle or motorcycle accidents, 25 (15.0%) were admitted in shock (blood pressure less than 90 mm Hg), the average Glasgow Coma Score was 13.2, and the average Injury Severity Score was 25.8. Treatment of the pelvic fracture included the following methods (alone or in combination): acute external fixation (45.0; 28.0%), open reduction/internal fixation (22; 13.5%), acute arterial embolization (11; 7.0%), and bedrest (68; 42.0%). Overall blood replacement averaged 5.9 units (lateral compression, 3.6 units; anteroposterior compression, 14.8 units; vertical shear, 9.2 units; combined mechanical, 8.5 units). Overall mortality was 8.6% (lateral compression, 7.0%; anteroposterior, 20.0%, vertical shear, 0%; combined mechanical, 18.0%). The cause of death was associated with the pelvic fracture in less than 50%; no patient with an isolated or vertical shear pelvic injury died. We conclude that the predictive value of our classification system (incorporating appreciation of the causative forces and resulting injury patterns) and our classification-based treatment protocols reduce the morbidity and mortality related to pelvic ring disruption.     

Radiology and the Health Policy Agenda for the American People

Eleven radiologists appointed by the major radiological societies participated for the past 5 years in the development of the Health Policy Agenda for the American People. The Agenda is an action plan to address a wide variety of serious problems in medicine. The first phase involved establishment of 159 principles, broad value statements that were the foundation of the project. Phase 2 involved the development of policy proposals on 38 urgent issues for action in medical science; education; health resources; delivery mechanisms; evaluation, assessment, and control; and payment for services. These proposals are summarized in this report. The activities and recommendations of representatives for the field of radiology are described. The Agenda has been released, and an implementation phase has begun. It will likely be of great importance to the practice of radiology over the next decade. Important issues can be addressed by acting with the coalitions that are being formed from among the more than 150 participating organizations.     

Cyclophosphamide 'pulses' in chronic progressive multiple sclerosis. A preliminary clinical trial

To our knowledge, this is the first clinical trial in multiple sclerosis (MS) demonstrating the feasibility of directing immunomodulating therapy by monitoring immunologic results. Cyclophosphamide was administered at monthly intervals, escalating the dose until there was a significant reduction in both the number of blood B lymphocytes and helper/inducer (CD4) T cells of 14 patients with chronic progressive MS. The frequency and severity of adverse effects led us to conclude that the regimen is too toxic for the long-term treatment of patients with MS.