Communication to an alarmed community about cancer clusters: A fifty state survey

A survey of all 50 U.S. states conducted in 1989 showed that 1,300–1,650 requests for cancer cluster investigations were received by state health departments. Most states responded with a three-stage process aimed at prioritizing clusters at each stage. Those situations deemed most serious were passed on to the next stage of evaluation. Thirty-eight of the 50 states said that communicating risk information to informants was a productive outcome, and 26 states sent materials to informants explaining the causes of cancer, clusters, how clusters are investigated, and other health education materials. Many states requested detailed information about reported clusters from informants. States with a major commitment to protecting public health and environment were more likely to provide information than states with weaker programs.Some officials discouraged people from pursuing their requests by trying to convince informants that a problem did not exist and by overwhelming them with questions and information. We recommend that health departments train their respondents in risk communications and establish an organizational climate that provides financial resources and institutional support appropriate to the complex task of communicating risk information to a public alarmed about a cancer cluster.Michael Greenberg is Distinguished Professor, Graduate Program in Public Health, and Department of Urban Studies and Community Health, Rutgers University; Daniel Wartenberg is Assistant Professor, Graduate Program in Public Health, and Department of Environmental and Community Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School.This research was supported by a grant from the New Jersey Department of Health.     

Detoxification of Alcoholics: Improving Care by Symptom-Triggered Sedation

This study evaluated a staff training program on alcohol detoxification. Training consisted of didactic presentations on the pathophysiology of alcohol withdrawal syndrome and information on use of the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-A). Treatment course was assessed on 100 patients admitted before or after the training. Whereas 73% of patients were given drug therapy before, only 13% of patients received drug therapy after. Significantly more benzodiazepine was administered before training (M = 108.48 mg) than after training (M = 42.97 mg). After excluding those who received no drug therapy, patients who received benzodiazepine after the training received significantly higher amounts of benzodiazepine (M = 252.50 mg) than those who received drug before (M = 144.64 mg). The average number of hours from the first benzodiazepine dose to the last was reduced from 13 to 5 hr. Clinical implications of matching patient symptomatology with appropriate drug therapy, thus preventing both over- and under-treatment for alcohol withdrawal symptoms, are discussed.     

The efficacy of standard laxative use for the prevention and treatment of opioid induced constipation during oxycodone use: a small Dutch observational pilot study

Background. Dutch clinical guidelines recommend that a standard laxative treatment (SLT) should be prescribed concomitantly when starting opioid treatment to prevent opioid-induced constipation (OIC).

Methods. Clinical evidence for SLT in the treatment of OIC is lacking, therefore an observational pilot study was performed to explore the efficacy and tolerability of SLT on OIC in patients treated with the opioid oxycodone.

Results. Twenty-four patients (58% female, median (range) age 65 (39–92)) were included in this pilot study. The analysis showed that 9 out of 21 patients (43%) were non-responders to SLT. When also taking into consideration patients tending to develop diarrhea 75% of patients are non-responsive to SLT.

Conclusion. This pilot study indicates that optimal laxative therapy (SLT) might not be effective and feasible for the prevention and treatment of OIC.     

Reversal of locked-in syndrome with anticoagulation,induced hypertension,and intravenous t-PA

Introduction: Widespread use of intravenous tissue plasminogen activator (t-PA) for acute ischemic stroke is limited by multiple contraindications to its use. Case report: This article describes a patient with stuttering symptoms of pontine ischemia caused by vertebrobasilar dissection who suddenly deteriorated into a locked-in state 32 hours after symptom onset. The quadriparesis was successfully reversed within 3 hours of onset with the combination of pharmacologically induced hypertension, anticoagulation, and intravenous t-PA. Discussion: Even in the face of numerous contraindications (including hypertension, anti-coagulation, and treatment beyond 3 hours of symptom onset), intravenous t-PA can be used successfully in carefully selected cases.     

Untersuchungen zur fluorescenz- und elektronenmikroskopischen Darstellung von 5-Hydroxytryptamin (5-HT) im Pineal-Organ von Lacerta viridis und L. muralis

Zusammenfassung Es wurden Pinealorgane (Epiphysis cerebri) ausgewachsener Eidechsen (Lacerta viridis und Lacerta muralis) mit der Falck-Hillarp Methode und dem Elektronenmikroskop untersucht, um 5-Hydroxytryptamin (5-HT) in den sekretorischen Pinealzellen zu bestimmen und zu lokalisieren. Die in dem Pinealorgan enthaltene Menge an 5-HT ist sehr groß (Gesamtmenge in Gehirn = 0,1998 g; Gesamtmenge in Pinealorgan = 0,0869 g=43%). Beim Vergleich der durch Fluorescenz- und Elektronenmikroskopie gewonnenen Resultate ergab sich, daß Pinealocyten zwei Formen von 5-HT enthalten. Die Hauptmenge ist in Granula mit einem durchschnittlichen Durchmesser von 1337±42 Å (L. muralis) lokalisiert, die von einer Elementarmembran umgeben sind, wodurch sie vom Cytoplasma getrennt sind (große, granulierte Vesikel zwischen 600 und 3000 Å). Dieser intravesiculäre 5-HT-Pool ist gegen Reserpinbehandlung relative resistent und scheint außerdem sehr fest an eine Protein-Matrix der Granula gebunden zu sein. Sogar nach 2 Dosen von 10 mg/kg Reserpin findet man nur eine Abnahme der relativen Fluorescenzintensität um etwa 50%. Das entspricht einer geringen, aber doch signifikanten Durchmesserabnahme des granulären Gehaltes nach Reserpin-Vorbehandlung, wogegen 2 Dosen von 300 mg/kg Nialamid keine sichtbaren Veränderungen an den Granula hervorrufen. Die zweite 5-HT-Form ist Bestandteil eines schnell verfügbaren, extravesiculären Pools, der über das gesamte Cytoplasma verteilt ist. Ab- und Zunahme der gelben Fluorescenz nach Reserpin oder Nialamid-Behandlung dürften im wesentlichen auf Einwirkung auf diesen extravesiculären Pool zurückzuführen sein. Elektronenmikroskopisch ist diese 5-HT Form schwer zu lokalisieren; jedoch führt eine Vorbehandlung mit Nialamid und 5-Hydroxytryptophan (5-HTP) zu einem starken Anstieg des extravesiculären Pools, in dessen Folge Orte mit hohen Konzentrationen an 5-HT-haltigen Substanzen sichtbar werden. Unter normalen Bedingungen stehen beide Poole in einem Gleichgewicht, und zwar in einer Weise, daß die Menge an extravesiculären 5-HT niedrig aber konstant gehalten wird.

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Studies on the fluorescence and electronmicroscopic identification of 5-hydroxytryptamine (5-HT) in the pineal organ of lacerta viridis and L. muralis

Summary The pineal organ (epiphysis cerebri) of adult lizards (Lacerta viridis and Lacerta muralis) has been studied by means of Falck's and Hillarp's method and electron microscopically with the aim to detect and localize 5-hydroxytryptamine (5-HT) in secretorial pinealocytes. The amount of 5-HT concentrated in the pineal organ is extremly high (total amount per brain = 0.1998 g; total amount per pineal organ = 0.0869 g=43%). Comparison of the results obtained by fluorescence and electron microscopy demonstrates that pinealocytes contain two types of 5-HT. The major amount is localized in granules with a diameter of 1337±42 Å (L. muralis). They are surrounded by a unit membrane separating the interior from the cytoplasm (=large granulated vesicles ranging between 600 and 3000 Å). This intravesicular pool of 5-HT is relatively resistent towards reserpine treatment and seems to be tightly bound to a protein matrix of the granules. Even after 2 doses of 10 mg/kg reserpine there is only a decrease of the relative fluorescence intensity of about 50%. That corresponds to a small but significant decrease in the diameter of the granular content after reserpine pretreatment whereas 2 doses of 300 mg/kg nialamide do not produce any observable alteration of the granules. The second type of 5-HT constitutes an easily available extravesicular pool spread over the cytoplasm. Increase and decrease of the yellow fluorescence after nialamid and reserpine treatment might be largely due to the influence on this extravesicular pool. Electron microscopically this type of 5-HT is difficult to localize; pretreatment with nialamide and 5-hydroxytryptophane (5-HTP), however, considerably increases the extravesicular pool and sites of large concentrations of 5-HT containing substances become visible. Under normal conditions both pools are balanced in such a way as to keep down and hold constant the amount of extravesicular 5-HT.

Mit dankenswerter Unterstützung durch die Deutsche Forschungsgemeinschaft.     

Chlorpyrifos accumulation patterns for child-accessible surfaces and objects and urinary metabolite excretion by children for 2 weeks after crack-and-crevice application

The Children's Post-Pesticide Application Exposure Study (CPPAES) was conducted to look at the distribution of chlorpyrifos within a home environment for 2 weeks after a routine professional crack-and-crevice application and to determine the amount of the chlorpyrifos that is absorbed by a child living within the home. Ten residential homes with a 2- to 5-year-old child in each were selected for study, and the homes were treated with chlorpyrifos. Pesticide measurements were made from the indoor air, indoor surfaces, and plush toys. In addition, periodic morning urine samples were collected from each of the children throughout the 2-week period. We analyzed the urine samples for 3,5,6-trichloropyridinol, the primary urinary metabolite of chlorpyrifos, and used the results to estimate the children's absorbed dose. Average chlorpyrifos levels in the indoor air and surfaces were 26 (pretreatment)/120 (posttreatment) ng/m3 and 0.48 (pretreatment)/2.8 (posttreatment) ng/cm2, respectively, reaching peak levels between days 0 and 2; subsequently, concentrations decreased throughout the 2-week period. Chlorpyrifos in/on the plush toys ranged from 7.3 to 1,949 ng/toy postapplication, with concentrations increasing throughout the 2-week period, demonstrating a cumulative adsorption/absorption process indoors. The daily amount of chlorpyrifos estimated to be absorbed by the CPPAES children postapplication ranged from 0.04 to 4.8 microg/kg/day. During the 2 weeks after the crack-and-crevice application, there was no significant increase in the amount of chlorpyrifos absorbed by the CPPAES children.     

Differentiation of serological responses to Yersinia enterocolitica serotype O9 and Brucella species by immunoblot or enzyme-linked immunosorbent assay using whole bacteria and Yersinia outer membrane proteins.

Serum samples from 134 patients showing by the microagglutination test serological cross-reactivity between Yersinia enterocolitica serotype O9 and Brucella spp. were analyzed by immunoblot and enzyme-linked immunosorbent assay techniques for the presence of antibodies directed against plasmid-encoded, yersinia-associated outer membrane proteins (OMPs). Since these OMPs are exclusively expressed in pathogenic strains of Yersinia spp., this characteristic was chosen for serological differentiation of infections caused by these bacteria. The presence of antibodies against plasmid-encoded OMPs of pathogenic Yersinia spp. in patient sera appeared to be a suitable means to identify acute or recent infection with Y. enterocolitica serotype O9, whereas the failure to detect such antibodies indicated an acute or recent infection with Brucella spp.