Knowledge and experience of young people of drug abuse 1969-84

An anonymous questionnaire survey of the knowledge and experience of drug abuse among fourth year pupils in three Wolverhampton secondary schools in 1969, 1974, 1979, and 1984 showed familiarity with the names of drugs but considerable ignorance and misunderstanding about how the drugs were taken and their dangers. The proportion of pupils who knew someone taking illicit drugs almost doubled over the period from 15% in 1969 to 28% in 1984, and the proportion of those who had been offered illicit drugs almost trebled, from 5% in 1969 to 14% in 1984. Television remained the most important source of information about drugs. Peer group and social pressures continued to be the most important reason for starting to take drugs. The results of this study endorse the need for continued evaluation of programmes of education about drugs. Such programmes must be part of a wider programme of health and social education, define clear goals, and be sensitive to culture, locality, and ability.     

A program for prevention in massachusetts

Since 1900 life expectancy at birth in the United States has increased by about 25 years, an increase attributable mainly to a decline in infant and child mortality. In place of deaths and disability from communicable diseases, the nation has witnessed a major increase in heart disease, cerebrovascular disease, lung cancer, cirrhosis of the liver, accidents, homicide, and suicide. These have been linked to human behavior, individual as well as collective. The Massachusetts Department of Public Health has embarked on a major new program in prevention. As the principal administrative unit within the state government charged with the protection and promotion of the somatic health of the citizens of the Commonwealth, the Department is in a unique position to play an important role in the development of strategies for health promotion. The Department has selected several target areas on which to concentrate its efforts, including: diet and nutrition, physical inactivity, substance abuse, tobacco and drugs, accidents, communicable diseases, and hypertension. Strategies for intervention include community and worksite demonstration projects, regulatory and legislative initiatives, school health programs, and the use of media. The Department has listed a modest program of goals and objectives to be reached within a 3-year period.     

Effect of increased dialysate volume on peritoneal surface area among peritoneal dialysis patients

Large dialysate volumes are often required to increase solute clearance for peritoneal dialysis patients. The resulting increase in solute clearance might be attributable to an increased plasma-to-dialysate concentration gradient and/or to an increased effective peritoneal surface area. One of the factors affecting the latter is the peritoneal surface area in contact with dialysate (PSA-CD). The aim of this study was to estimate the change in PSA-CD after a 50% increase in the instilled dialysate volume for patients undergoing peritoneal dialysis. PSA-CD was estimated by using a method applying stereologic techniques to computed tomographic (CT) scans of the peritoneal space. The peritoneal cavity of 10 peritoneal dialysis patients was filled with a solution containing dialysate, half-isotonic saline solution, and contrast medium. Peritoneal function tests and CT scanning of the abdomen were performed twice for each patient (with an interval of 1 wk), after instillation of a 2- or 3-L solution. Scanning of thin helical CT sections was performed, and 36 random sections of the abdomen were obtained after reconstruction. A grid was superimposed on the sections. The surface area was estimated by using stereologic methods. After instillation of the 2-L solution, the volume of the peritoneal solution at the time of CT scanning was 2.32 +/- 0.05 L. The PSA-CD was 0.57 +/- 0.03 m(2), ranging from 0.41 to 0.76 m(2). The use of the 3-L solution increased the peritoneal volume by 46 +/- 2%. PSA-CD increased by 18 +/- 2.3% to 0.67 +/- 0.04 m(2) (range, 0.49 to 0.84 m(2); P < 0.01). Creatinine mass transfer increased from 112 +/- 10 mg to 142 +/- 11 mg (P < 0.0001). The slope of the change of the plasma-to-dialysate creatinine concentration gradient with time decreased from -2.26 +/- 0.23 x 10(-2) to -1.97 +/- 0.16 x 10(-2) (P = 0.01). K(BD-0) (permeability-surface area product or mass area transfer coefficient at time 0 of the dwell) increased from 10.6 +/- 0.7 to 13.6 +/- 1.2 ml/min (P < 0.02). These data demonstrate that increasing the instilled dialysate volume by 50% for peritoneal dialysis patients results in significant increases in the PSA-CD and K(BD).     

Decreased cortisol secretion in nonclassical 21-hydroxylase deficiency before and during glucocorticoid therapy

OBJECTIVE: The cortisol response in patients with nonclassical 21-hydroxylase deficiency (NC21OHD) was assessed before and during hydrocortisone therapy and the findings were related to genotype. DESIGN: Comparative study. METHODS: The study sample comprised 41 patients (10 males) with NC21OHD, divided into two groups according to the genetic analysis of the CYP21 gene: Group A carried two mild mutations (n = 29), and Group B were compound heterozygotes for one mild and one severe mutation (n = 12). The 250 microg short ACTH test was performed at diagnosis. To evaluate the degree of treatment-induced suppression of adrenal function, 31 patients also underwent the 1 microg/1.73 m2 ACTH test during hydrocortisone therapy. Basal and stimulated cortisol levels and the increment in cortisol response were compared between Groups A and B and between the whole patient sample and healthy controls (32 subjects for the 250 microg test and 29 for the 1 microg/1.73 m2 test). RESULTS: The basal, stimulated, and incremental cortisol levels were similar in Groups A and B; therefore, all the patients were considered together. At diagnosis, the basal cortisol levels were similar in the patients and controls, but the stimulated and incremental cortisol levels were significantly lower in the patients (p <0.001 for both). During hydrocortisone therapy, the patients had slightly higher basal cortisol levels than the controls (p = 0.04), but significantly lower stimulated and incremental cortisol levels (p <0.001 for both). CONCLUSIONS: Cortisol levels in NC21OHD are similar in patients carrying two mild mutations and in compound heterozygotes for one mild and one severe mutation. Stimulated and incremental cortisol levels in response to the short ACTH test might be decreased not only during but also before hydrocortisone therapy. Therefore, coverage with a stress dose of hydrocortisone during serious intercurrent illness or surgery is recommended in patients with NC21OHD, especially those previously treated with corticosteroids.     

Outcomes of endometrial cancer patients undergoing surgery with gynecologic oncology involvement

OBJECTIVE: This study was undertaken to compare the outcomes of patients with endometrial cancer who had primary surgery with gynecologic oncology involvement at university or community hospitals. METHODS: The study population consisted of all patients who had primary surgery for endometrial cancer with involvement of the attending physicians of the Division of Gynecologic Oncology. The patients were divided into two groups based on whether their surgery was performed at a university or community hospital. Demographic and clinical data were abstracted from the medical records. RESULTS: There were no significant differences between the two groups with regard to Quetelet index (kg/m(2)); intervals between biopsy and consultation, consultation and surgery, and biopsy and surgery; estimated blood loss; incidence of operative or hospital complications; frequency of appropriate surgical staging; stage distribution; histology or grade; and hospital stay. Patients at a university hospital were significantly older, had a higher severity index, were more likely to have had a vaginal hysterectomy, and participate in a research protocol. Both the Quetelet index and the severity index were significantly higher for patients who had vaginal hysterectomy than for those who had either laparoscopically assisted vaginal hysterectomy or total abdominal hysterectomy. When analyzed by surgical approach, the frequencies of pelvic and paraaortic lymph node sampling were comparable between the groups. Both the Quetelet and severity indices were significantly higher for patients who did not have lymph node sampling. CONCLUSION: Involvement of a gynecologic oncologist at the time of primary surgery for endometrial cancer was associated with comparable outcomes in both the university and community hospital setting.     

Early failure of the Shelhigh pulmonary valve conduit in infants

BACKGROUND: The ideal valved conduit for right-sided (pulmonary) reconstruction in infants and children remains elusive. Desired characteristics include availability, ease of implantation, and longevity. Cryopreserved homografts are most commonly used, but availability of small sizes and limited durability remain problematic. The Shelhigh porcine-valved conduit (SPVC) with its No-React anticalcification properties was developed as a potential alternative to homografts. METHODS: During a 10-month period, 8 patients underwent seven successful SPVC implantations. Median age was 9.5 days. Six conduits were less than 12 mm in diameter (range, 9 to 19 mm). RESULTS: The early and late survival rates were 100%. During a mean follow-up of 18 months, five conduits were replaced at 6, 10, 12, 12, and 13 months for severe obstruction. Actuarial conduit failure at 12 months was 72%. Explanted SPVCs demonstrated marked pseudointimal peel formation along the original intima with an intense granulomatous inflammatory reaction. The intimal reaction was severely fibrogenic, but calcification was not present. For comparison, we retrospectively reviewed the cases of 23 infants receiving cryopreserved homografts during an overlapping period. Twelve patients, 6 of them neonates, were less than 90 days old. Mean homograft size was 13 mm (range, 8 to 15 mm), with nine less than 13 mm. During a mean follow-up of 26 months, six conduits were replaced at 7, 12, 12, 16, 20, and 35 months (sizes 13, 17, 14, 12, 10, and 12 mm, respectively). Only three of nine homografts less than 13 mm in size were replaced during a mean follow-up of 12 months. The overall homograft replacement rate was 17% at 22 months (p = 0.005) compared with the SPVC). CONCLUSIONS: Although the SPVC appears to resist calcification, a marked foreign-body type of reaction results in pseudointimal peel formation and early conduit stenosis. In its present configuration, the SPVC in not a suitable valved conduit for use in infants. Although not ideal, the cryopreserved homograft has superior longevity to the SPVC.