High yield of chest radiography in walk-in clinic patients with chest symptoms

Purpose: To assess the yield of chest radiography among a group of symptomatic adults presenting to a walk-in clinic. Patients and methods: Outpatients presenting to a walk-in clinic for evaluation of cough, shortness of breath, or pleuritic chest pain were interviewed by nurses who recorded clinical data pertaining to the present illness and past medical history. Chest radiographs were then obtained prior to physician evaluation. Results: A total of 221 patients were enrolled in the study; 97% were men and the mean age was 62 (±10.3) years. New clinically important radiographic abnormalities, defined as those necessitating acute intervention and/or follow-up evaluation, were identified for 77 (34.8%) of the 221 patients studied. Abnormalities included 39 (17.6%) cases of infiltrates, 23 (10.4%) cases of nodules or mass lesions, and 19 (8.6%) cases of cardiomegaly or congestive heart failure. Evaluation of clinical data obtained during the triage interview revealed no statistically significant difference between those patients with and those without new radiographic abnormalities on their chest x-rays. Conclusion: Adult patients similar to those described in this study who present to a walk-in clinic with a chief complaint of cough, dyspnea, or pleuritic chest pain have a high likelihood of having new clinically important abnormalities found on their chest radiographs. Since patient characteristics did not predict which patients were more likely to have abnormal findings, the practice of obtaining chest radiographs for such individuals at the time of triage and prior to physician evaluation appears justified. Received from the Department of Medicine, Minneapolis Veterans Affairs Medical Center, University of Minnesota, Minneapolis, Minnesota. Presented in part at the Fifth Annual Midwest Regional Meeting of the Society of General Internal Medicine, Chicago, Illinois, November 12, 1988.     

Benzoyl peroxide activation of protein kinase C activity in epidermal cell membranes

We have investigated the effects of various tumor promotingagents on protein kinase C activity in adult female SENCAR mice.Topical application of benzoyl peroxide increased the calcium-independentactivity of protein kinase C in the particulate fraction ofbasal epidermal cells while decreasing protein kinase C activityin the soluble fraction of basal epidermal cells isolated fromthe mice. Benzoyl peroxide apparently altered protein kinaseC indirectly, as it had no direct effect on the activity ofprotein kinase C partially purified from bovine brain. Topicalapplication of 12-O-tetradecanoyl phorbol-13-acetate to mouseskin resulted in increased protein kinase C activity associatedwith the particulate fraction of the epidermal cells with nochange in the calcium-dependence of the enzyme. Since the proliferativeagent ethylphenylpropiolate had no effect on protein kinaseC in epidermis from SENCAR mice, the ability of benzoyl peroxideto influence protein kinase C activity in mouse skin may reflectits tumor promoting capabilities rather than its ability toinduce hyperplasia.     

Differential Disposition of Soluble and Liposome-Formulated Human Recombinant Interleukin-7: Effects on Blood Lymphocyte Population in Guinea Pigs

The effects of liposome formulation on interleukin-7 (IL-T)-dependent lymphopoietic activity was investigated based on the pharmacokinetics and tissue distribution profile of soluble and liposome-formulated recombinant human IL-7. Using ¹²⁵I-IL-7, we determined the role of liposome formulation on in vivoIL-7 disposition by analyzing injection site, blood, tissue, and urinary kinetics. Following a 30- to 40-µg subcutaneous dose of soluble IL-7, most of the IL-7 was eliminated through urinary excretion within 24 hr. An equivalent subcutaneous dose of liposome-encapsulated IL-7 resulted in a peak level less than one-tenth that seen with soluble drug but produced sustained blood and urinary levels for 5 days. The bioavailability of liposome-encapsulated IL-7 was comparable to that of soluble IL-7, as determined by both blood and urinary data. Kinetic analysis of IL-7 at the subcutaneous injection site indicated that liposome encapsulation significantly reduced the rate of disappearance at the injection site. Studies with a mixture of 40% liposome-encapsulated and 60% soluble IL-7 gave an intermediate response between that of soluble IL-7 and that of liposome-encapsulated IL-7. Characterization of blood cells from IL-7-treated animals indicated that treatment with two weekly doses of mixed IL-7 liposomes (40% liposome encapsulated IL-7) significantly increased the total numbers of lymphocytes by day 14. In contrast, animals treated with soluble IL-7 on an identical dose and schedule did not produce any effect on blood lymphocytes. Collectively, liposome formulation provided a lower, but significantly sustained blood IL-7 level that enhanced IL-7 effects on blood lymphocyte numbers.     

The Colorado Tobacco-Free Schools and Communities Project

ABSTRACT: This article defends the appropriateness of tobacco-free school policies as an effective tool toward ensuring young people develop into healthy and intellectually strong adults, and demonstrates how such a policy can be introduced into a school district. Health education efforts to eliminate tobacco use are widely considered more effective when carried out in concert with school policies and adult role models offering the consistent message that tobacco use is unhealthy and unacceptable. Studies indicate students who attend schools with strict smoking policies are less likely to begin smoking than students who attend schools without such policies. Through research, support, and guidance, the Colorado Tobacco-Free Schools and Communities Project successfully has assisted almost half the 176 school districts in Colorado to adopt such policies.