Agreement between DSM-III, DSM-III-R, DSM-IV and ICD-10 alcohol diagnoses in US community-sample heavy drinkers

DSM-III-R, DSM-IV and ICD-10 definitions of alcohol dependence were all developed from the concept of the Alcohol Dependence Syndrome, and thus have a common theoretical link. This link is not shared by DSM-III, and no link exists between definitions of abuse in the different classification systems. The level of agreement on diagnoses produced by the different systems has practical as well as theoretical implications. We tested this agreement in 962 US household residents randomly sampled and screened for heavier than average drinking in the last 12 months. Agreement for most comparisons involving diagnoses of current dependence ranged from good to excellent, with no clear pattern of lower agreement for DSM-III. However, agreement on past dependence was sharply lower for comparisons involving DSM-III than those involving the other classification systems. This appeared to be due to the DSM-III requirement for physiological dependence and the apparently emerging nature of the disorder in this relatively young, non-treatment sample. Comparisons for abuse were generally poor for current as well as past diagnoses. Implications of the findings are discussed.     

A Comparison of External Rate Responsive Pacemakers With Identical Implanted Units

Seven patients with previously implanted accelerometer-based DDDR pacemakers had an identically programmed external pacemaker taped onto their chest. Both units underwent a simultaneous test to set the sensitivity of the accelerometer. The units were then programmed to record the pacing rates for a 15-minute period. The patients underwent an exercise course that included walking and stairs. After the exercise, the patients sat for 3 minutes and the pacing rates from the test were telemetered. The pacing rate was compared at 2 minutes, 4 minutes, peak, and 3 minutes postexercise. The mean standard deviation (SED) for the external pacemaker was 97.9 at 3.53 ppm, 102 at 10.6 ppm, 106 at 8.94 ppm, and 71.3 at 2.29 ppm at 2, 4, peak, and decay, respectively. The mean SEDfor the implanted pacemaker was 98.1 at 5.76 ppm, 100 at 10.2 ppm, 104 8.24 ppm, 72.4 at 2.88 ppm at 2, 4, peak, and decay, respectively. Difference between pacemakers in ppm was 0.286, 2.0, 2.71, and 1.14 at 2, 4, peak, and decay, respectively. A 95% confidence interval in ppm was - 5.28 to 5.85, - 10.1 to 14.1, - 7.30 to 12.7, and - 1.89 to 4.17 at 2, 4, peak, and decay, respectively. In all patients there was a high confidence correlation between the implanted and external unit. An external unit can be used to predict the rate response of an accelerometer-based pacemaker without any adjustments to the pacing parameters.     

Substitution of aromatic and nonaromatic amino acids for the Phe3 residue in the δ-selective opioid peptide deltorphin I: Effects on binding affinity and selectivity

Deltorphins I and II (Tyr-D-Ala-Phe-Asp-Val-Val-Gly NH₂ and Tyr-D-Ala-Phe-Glu-Val-Val-Gly NH₂) display a high degree of 6-opioid receptor selectivity. Since they lack the intervening Gly3 residue found between the Tyr and Phe aromatic moieties in pentapeptide enkephalins, deltorphins I and II resemble a previously described series of cyclic tetrapep-tides based on Tyr-c[D-Cys-Phe-D-Pen] (JOM-13). With the goal of development of structure-activity relationships for deltorphins and comparison with that of the cyclic tetrapep-tides, ten analogs of deltorphin I were synthesized in which Phe³ was replaced with specific aromatic and nonaromatic amino acids with varying physicochemical properties. Results indicated that analogs containing the bicyclic aromatic amino acids 3-(l-naphthyl)-L-alanine [1-Nal; K_i(μ) = 767 nM, K_i(§) = 7.70 nM], 3-(2-naphthyl)-L-alanine [2-Nal; K_i(μ)= 1910 nM, K_i(§) = 49.2 nM], tryptophan [K_i(μ)= 1250 nM, K_i(§) = 23.9nM], and 3-(3-benzothienyl)-L-alanine [Bth; K_i(μ)= 112nM, K_i(§) = 3.36 nM] were fairly well tolerated at μ- and §-receptors, though affinity was compromised to varying degrees relative to deltorphin I. Shortening the Phe side chain by incorporation of phenylglycine (Pgl) was detrimental to both μ (K_i= 4710 nM) and § (K_i= 15.6 nM) binding, while extension of the side chain with homophenylalanine (Hfe) enhanced μ binding (K_i= 67.8 nM), leaving § affinity unaffected (K_i= 2.64 nM). Substitution with nonaromatic amino acids valine and isoleucine led expectedly to poor opioid binding [K_i(μ) =≥ 10000 nM for each, K_i(§) = 160 and 94.7 nM, respectively], while peptides containing cyclohexylalanine (Cha) and leucine surprisingly retained affinity at both μ (K_i= 322 and 1240 nM, respectively) and § (K_i= 10.5 and 12.4 nM, respectively) sites. In general, these trends mirror those observed for similar modification in Tyr-c[D-Cys-Phe-D-Pen].     

Epithelial markers in primary skin cancer: an immunoperoxidase study of the distribution of epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA) in 65 primary skin carcinomas

Sixty-five primary malignant skin tumours have been stained for carcinoembryonic antigen (CEA) and epithelial membrane antigen (EMA) using rabbit polyclonal affinity-purified antibodies and an indirect immunoperoxidase technique. The tumours consisted of 15 invasive squamous carcinomas, 23 basal cell carcinomas, 16 malignant eccrine poromas (porocarcinomas), and 11 sebaceous carcinomas. The basal cell carcinomas were negative for CEA and EMA except where there was keratotic or sebaceous differentiation. All the sebaceous and squamous carcinomas and 15/16 porocarcinomas contained EMA. 12/15 squamous carcinomas were positive for CEA. The malignant poromas were negative for CEA except on the ulcerated surface of two. In tumours classified as sebaceous carcinomas there was positive staining for CEA in some cells, cyst contents and/or keratotic foci. These findings have implications for the use of immunoperoxidase localization of epithelial markers in the differential diagnosis of primary and metastatic skin cancer.     

Loss of lanolin patch-test positivity

Summary Thirty-seven patients who had shown a relevant positive patch-test response to lanolin within the previous 5 years were retested. Only 41% demonstrated persistence of the positive patch test to lanolin. Analysis according to age, sex, atopic status, interval between patch testings, strength of the original response and the number of concurrent reactions, were not associated with the persistence of the lanolin response.     

DEVELOPMENT OF A RENAL TUMOR MIMIC MODEL FOR LEARNING MINIMALLY INVASIVE NEPHRON SPARING SURGICAL TECHNIQUES

PURPOSE: New laparoscopic partial nephrectomy and tumor ablation techniques are continuously being developed and evaluated in large animal models. However, to our knowledge no reliable renal tumor model exists to evaluate procedure efficacy. We developed and assessed the reliability of a tumor mimic model to serve as a training tool for minimally invasive kidney surgery. MATERIALS AND METHODS: An agarose based model was created using a mixture of 3% agarose, 3% cellulose, 7% glycerol and 0.05% methylene blue. It is liquid when heated, but solidifies after cooling to physiological temperatures. The agar was injected (0.7 cc) into porcine renal parenchyma to make endophytic or completely intraparenchymal lesions. Three-dimensional ultrasound images of the lesions were obtained during initial development to ensure spherical lesions. A group of 20 lesions was initially placed in an ex vivo setting to assess size consistency and define baseline impedance characteristics. An additional 20 tumor mimics each were established in a laparoscopic model in a laparoscopic box trainer and an in vivo laparoscopic model. They were ablated with a temperature based radio frequency generator to assess impedance characteristics but the efficacy of ablation was not assessed. The in vivo model consisted of placing the agar lesion percutaneously under direct laparoscopic vision. RESULTS: The agarose mixture was easily injected and readily visible on ultrasound as hyperechoic distinct lesions. Lesions had a mean size of 10.8 +/- SD 1.3 mm on ultrasound and 10.9 +/- 1.2 mm grossly. The impedance of normal renal parenchyma and unablated lesions was similar. Mean lesion size in the ex vivo model after radio frequency ablation was 9.8 +/- 2.0 mm on ultrasound, which was similar to the gross mean lesion size of 9.7 +/- 1.0 mm. Similar results were obtained for the in vivo model with a mean size of 10.1 +/- 2.1 and 10.4 +/- 1.5 mm, respectively. The lesions were easily identified grossly as blue solid lesions that replaced renal parenchyma. CONCLUSIONS: The described renal tumor mimic model reproducibly creates ex vivo and in vivo porcine kidney lesions. Lesion size and impedance do not change with the application of radio frequency energy. This model should be a valuable adjunct in the development, assessment and teaching of novel, nephron sparing, minimally invasive surgical techniques.     

LATCH: A Breastfeeding Charting System and Documentation Tool

Nurses most often use a subjective "well/fair/poor" system to assess and document breastfeeding. LATCH is a breastfeeding charting system that provides a systematic method for gathering information about individual breastfeeding sessions. The system assigns a numerical score, 0, 1, or 2, to five key components of breastfeeding. Each letter of the acronym LATCH denotes an area of assessment. "L" is for how well the infant latches onto the breast. "A" is for the amount of audible swallowing noted. "T" is for the mother's nipple type. "C" is for the mother's level of comfort. "H" Is for the amount of help the mother needs to hold her infant to the breast. The system is visually represented in the same form as the Apgar scoring grid, and the numbers are handled in the same way. With the LA TCH system, the nurse can assess maternal and infant variables, define areas of needed intervention, and determine priorities in providing patient care and teaching.     

Effects of Tactile Stimulation on Premature Infant Weight Gain

A study was conducted to determine the effect of continuous tactile stimulation on weight gain in premature infants. Thirty infants made up the sample. The experimental group received continuous tactile stimulation by being placed on a pile decubitus pad for a five-day period. Infants in the control group received routine nursery care. Both groups were weighed daily on the same scale. Analysis of covariance was used to analyze the data, which resulted in a failure to reject the hypotheses of no difference.