Tobacco use prevention and cessation programs in the U.S. Navy.

A representative sample of 406 U.S. Navy commands, including all medical treatment facilities, was surveyed in 1990 about their activities and programs to prevent the use of tobacco and promote smoking cessation during the preceding year. The vast majority of Navy commands (86 percent) provided some type of tobacco cessation educational materials or programs. However, the most common activities typically were rated as only "somewhat useful" in helping to curb tobacco use. Almost one-half of all commands offered psychological or behavioral cessation programs. Survey respondents estimated that approximately one-third of those persons who attended such a program stopped their tobacco use and nearly one-half reduced their tobacco use as a result of the program. Over-the-counter smoking cessation aids were not widely available at Navy exchange stores, individual commands, or medical treatment facilities. Furthermore, only 61 percent of all commands reported that they had a written policy or instruction regarding tobacco use. Only about one-third of medical treatment facilities had a routine system for identifying tobacco users by glancing at their medical records. However, it was estimated that 80 percent of medical treatment facility physicians routinely asked their patients about their tobacco use. The authors discuss the need for a more active Navy approach in prevention and cessation efforts and a routine system for identifying tobacco users from their medical records. In addition, inequities in cessation efforts were found among command subgroups.     

Anaesthesia for Caesarean section in a patient with Watson’s syndrome

Watson’s syndrome is an uncommon genetic disorder whose features include mental retardation and pulmonary valvular stenosis. The purpose of this report is to describe one management strategy used successfully to anaesthetize a woman with this disorder who presented for Caesarean section. Epidural anaesthesia using 0.5% bupivacaine without epinephrine in 2–3 ml boluses to a total dose of 15 ml was administered over 30 min. Invasive haemodynamic monitoring in the form of arterial and central venous catheters were used to guide therapy and help ensure maternal and fetal well-being. Intravenous ketamine in doses of 10–20 mg every five minutes to a total dose of 245 mg (4.5 mg · kg^?1) was used to overcome the patient’s uncooperative nature and facilitate invasive procedures. Postoperative analgesia was provided using 3 mg epidural morphine. The patient was observed in the intensive care unit for the first postoperative day and experienced an uncomplicated intra- and postoperative course. We conclude that this technique represents a safe and effective method for anaesthetizing patients with this complicated problem for Caesarean section.     

Hereditary breast cancer and family cancer syndromes

Hereditary breast cancer (HBC) shows extant clinical and genetic heterogeneity. Clinically one finds the onset of breast cancer at an early age, an excess of bilaterality, and patterns of multiple primary cancer such as combinations of breast and ovarian carcinoma in the hereditary breast-ovarian cancer (HBOC) syndrome. In addition to HBOC, one sees a variety of putative breast cancer-prone genotypes inclusive of hereditary site-specific breast cancer, and the Li-Frameni (SBLA) syndrome that is characterized by cancers involving all three germinal layers including sarcomas, brain tumors, leukemia, lymphoma, and adrenal cortical carcinoma in addition to often markedly early-onset breast cancer. Breast cancer is also associated with autosomal dominantly inherited Cowden's disease and autosomal recessively inherited ataxia-telangiectasia. Examples of pedigrees depicting clincal examples of these several HBC syndromes are presented in order to describe HBC's heterogeneity. The recent identification of the BRCA1 gene in early-onset hereditary sitespecific breast cancer and the HBOC syndrome has led to new challenges for the genetic counselor. We review genetic counseling, which embraces surveillance and management recommendations that are responsive to the natural history of HBC and address the concept for future development of centers of expertise for HBC in the interest of improving cancer control.

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Resumen El cáncer mamario hereditario (CMH) exhibe una gran heterogeneidad clínica y genética. Desde el punto de vista clínico, se observa el comienzo del cáncer mamario en una edad temprana, una tasa considerable de bilateralidad, y patrones de múltiples cánceres primarios, tal como la combinación de carcinomas mamario y ovárico en el síndrome del cáncer de seno-ovario hereditarios (CSOH). Además del CSOH, se puede observar una variedad de genotipos putativos propensos al cáncer, incluyendo el cáncer mamario hereditario de ubicación específica y el síndrome de Li-Fraumeni, que se caracteriza por cánceres que afectan a todas las tres capas germinales, incluyendo sarcomas, tumores cerebrales, leucemia, linfoma y carcinoma adrenocortical, además de un notorio comienzo precoz del cáncer mamario. El cáncer mamario también se asocia con la enfermedad de Cowden hereditaria y autosómica dominante y con la ataxia-telangiectasia autosómicamente recesiva. Se presentan ejemplos de pedigríes que ilustran diversos síndromes de CMH, con el objeto de demostrar la heterogeneidad del CMH. La reciente identificación del gen BRCA1 en el cáncer mamario hereditario, de ubicación específica y de comienzo temprano, y el sindrome CSOH, ha significado nuevos desafíos para el consejero genético. En este artículo hacemos una revisión de la consejería genética que se refiere a la vigilancia y a las recomendaciones sobre manejo que corresponda a la historia natural del CMH, y enfocamos el concepto en cuanto al desarrollo de centros de especializados en CMH, con el propósito de mejorar el control del cáncer.

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Résumé Le cancer du sein héréditaire (CSH) est cliniquement et génétiquement hétérogène. au point de vue clinique, le cancer dbute habituellement à un âge jeune, est souvent bilatéral, et est parfois associé à d'autres cancers primitifs, comme par exemple dans le syndrome de cancer héréditaire du sein et de l'ovaire (SCO). On peut également observer d'autres génotypes présumés susceptibles de donner des cancers du sein héréditaires ainsi que le syndrome Li-Fraumeni (SBLA), caractérisé par l'envahissement des trois couches germinales et comprenant les tumeurs sarcomateuses, les tumeurs du cerveau, les leucémies, les lymphomes, et des cancers des corticosurrénales associées à des cancers du sein à un âge précoce. Le cancer du sein est parfois associé à la maladie de Cowden, une maladie autosomique dominante, et la télangiectasie ataxique, une maladie autosomique récessive. Des exemples de pedigrees de plusieurs types des CSH sont présentés, soulignant l'hétérogénéité de ce syndrome. La plus récente identification du gène BRCA1 et son rôle dans le cancer du sein et le syndrome HBOC est un nouveau challenge pour le généticien d'aujourd'hui. Nous passons en revue nos attitudes de conseil génétique comprenant à la fois les recommandations de surveillance nouveau challenge pour le généticien d'aujourd'hui. Nous passons en revue nos attitudes de conseil génétique comprenant à la fois les recommandations de surveillance et d'attitude thérapeutiques compatibles avec l'histoire naturelle des CSH, et qui ont trait au développement future des Centres spécialisés pour évaluer ces CSH dans le but l'améliorer leur contrôle.

     

Relationship between overnight energy expenditure and BMR measured in a room-sized calorimeter

OBJECTIVE: The purpose of this study was to determine if overnight energy expenditure, the lowest energy expenditure sustained for 60 min during the night, measured and predicted basal metabolic rate are equivalent. DESIGN: Overnight energy expenditure (ON-EE), the lowest energy expenditure sustained for 60 min during sleep (LS-EE) and basal metabolic rate (BMR) were measured two to seven times in a room-sized indirect calorimeter in 69 adult subjects. Subjects' gender, age, weight and height were also used to predict BMR (FAO/WHO/UNU, 1985) (BMR-WHO). SETTING: Beltsville Human Nutrition Research Center, Beltsville, MD, USA. RESULTS: The results from calorimetry measurements (mean +/- s.d.) included: ON-EE (6.87 +/- 0.99 MJ/d), LS-EE (6.18 +/- 0.94 MJ/d) and BMR (6.87 +/- 0.99 MJ/d). Predicted BMR mean was: BMR-WHO, 6.95 +/- 1.03. The mean within-subject difference for the calorimetry measurements were: ON-EE, 0.21 MJ/d; LS-EE, 0.16 MJ/d; and BMR, 0.34 MJ/d. Results indicate there was no significant difference between ON-EE, BMR and BMR-WHO. LS-EE was significantly lower (P < 0.0001) than ON-EE, BMR and BMR-WHO. CONCLUSION: These results indicate that while metabolic rate drops significantly below BMR during sleep, overnight metabolic rate and BMR are equivalent.     

A comparison of the haemodynamic effects of intrathecal meperidine,meperidine-bupivacaine mixture and hyperbaric bupivacaïne

Purpose

To study the haemodynamic effects of intrathecal meperidine, administered either alone or mixed with bupivacaïne.

Methods

We studied 42 Chinese patients, aged 59–87 yr, scheduled for transurethral bladder or prostate surgery, randomized into three equals groups, that received either meperidine 0.8 mg · kg^{?1 meperidine 0.4 mg} · kg^?1 plus 1.5 ml of 0.5% heavy bupivacaïne or 3 ml of heavy bupivacaïne 0.5%. Non-invasive systolic (SAP) and mean (MAP) arterial pressures, central venous pressure and cardiac index, stroke index and heart rate (HR) measured by the BoMed NCCOM3-R7S bioimpedance device, were recorded over the first 25 min. Systemic vascular resistance index (SVRI) was derived. Onset of sensory and motor block was also measured. Decreases in MAP of 25% were treated with colloid and metaraminol. Results: The onset of block was slower in the meperidine group (P < 0.05). Decreases in SAP, MAP and SVRI (all; P < 0.001) occurred within five minutes in all three groups. The HR was increased in the bupivacaïne group (P = 0.03), but bradycardias treated with atropine occurred in six patients receiving meperidine and four patients receiving the mixture. Six patients receiving meperidine and two patients receiving the mixture required general anaesthesia for inadequate block. The incidence of nausea and vomiting was higher in the patients receiving meperidine (P < 0.05). No other complications were encountered.

Conclusions

Intrathecal meperidine used alone or mixed with bupivacaïne has no intra-operative advantage over heavy bupivacaïne 0.5%.     

Film loan policies of radiology departments

Last year, the AHRA Southern Region Statistical Resource Committee surveyed its members about their departments' film loan policies. This article presents the results of that survey, providing information on such topics as lending original films, charging for copies, and protecting against liability. While there doesn't seem to be a standard approach to releasing films, survey findings suggest that liability issues and cost factors are of great concern in determining which policy should be adopted.     

AHRA survey. Staff utilization: Part I

Part I of this AHRA membership survey reports on information relating to staff utilization in diagnostic radiology. The average volume of procedures per full-time-equivalent staff is provided for technologists, physicians, clerical staff and transporters. Part II, to be published in the Summer issue, will provide reports on specialty areas in radiology.     

AHRA survey. Staff utilization: Part III

Part III is the final installment of the 1993 AHRA membership survey on staff utilization and includes results for radiation therapy, nuclear medicine, interventional/angiography and cardiac catheterization. The information includes the volume of procedures and numbers of FTEs in departmental areas and comparisons with results reported from a similar survey of AHRA members conducted in 1989.