Determinants of condom use among intravenous drug users in Spain

Attitudes to and perception of health care delivery are consideredto be important factors for patient compliance in diabetes.To Investigate insulin-treated diabetic patients' use of, experienceof and attitudes to diabetes care a questionnaire was sent to561 patients, 20–50 years old, living in northern Sweden.Four hundred and eighty-eight patients (87%) participated inthe study. Data were analysed against social, medical and geographicalbackground factors. Female patients more often than men hadseen an ophthalmologist (93 versus 87%, p<0.05), a diabetesnurse specialist (74 versus 64%, p<0.05) and a chiropodist(49 versus 30%, p<0.001) at least once during the courseof their diabetes. Women also used the services of a medicalsocial worker (17 versus 10%, p-0.05) or a psychologist (14versus 8%, p<0.01) more often. More men than women were satisfiedwith the health care they had at the onset (65 versus 38%, p<0.001),but no gender difference in attitude to their present care wasfound. Diabetic patients with chronic complications comparedto those without were less satisfied both with the care theyreceived at the onset of diabetes (40 versus 61%, p<0.001)and at the time they answered the questionnaire (59 versus 72%,p<0.01). Patients in the most sparsely populated health districtwere more seldom able to be seen by the same physician (70 versus93% and 94%, p<0.001) and patient-physician continuity waspoorer over a 3 year period (48 versus 80%, p<0.001). Basedon results of this study, we conclude that use of, experienceof and attitudes to diabetes care are primarily related to genderand sickness factors. Living in sparsely populated areas probablyaffects the use and continuity of hearth care depending on themeans available. The differences demonstrated might be an argumentfor planning more individualized care for diabetic patientsin the future.     

Anaesthetic management of the surgical separation of a pair of thoracopagus-cardiopagus twins

We describe the anaesthetic management of the surgical separation of a pair of thoracopagus-cardiopagus twins with a common right atrium and a myocardial tissue bridge containing vascular channels between their ventricles. One of them died during the procedure, the surviving twin is now two years old. The survival of one twin for two years without significant sequelae, after the surgical separation of twins with shared right atrium and fused ventricles, has not previously been reported. Careful preoperative assessment is essential to anticipate potential serious problems during the procedure.     

Reduced activation of epidermal phosphorylase in the lesions of psoriasis

The percentage activation of the enzyme phosphorylase in extracts prepared from the epidermis of psoriatic lesions was found to be significantly lower than normal. This observation lends strong support to the concept of a reduced level of cyclic AMP in the lesion of this disease.     

Clinical Benefit of Dual Chamber Pacing in Hypertrophic Cardiomyopathy: A Case Report

This case study presents evidence that angioplasty and dual chamber pacing can be used as a therapeutic alternative to coronary artery bypass grafting and myectomy. The following case report describes this treatment option in a patient with hypertrophic Cardiomyopathy and ischemic heart disease who refused surgery. A severe coronary lesion was successfully treated with percutaneous transluminal coronary angioplasty (PTCA), Subsequent deterioration of the patient's clinical status occurred, yet a repeat heart catheterization revealed no angiographic changes from the PTCA. The left ventricular outflow gradient was 97 mmHg despite optimizing medical therapy. Temporary pacing leads were inserted and the patient was DDD paced at 70 ppm while measuring the LVgradient at varying A V intervals. Significant reduction of the outflow tract gradient occurred at all A V intervals tested. Although the pressure gradient decreased during VVI pacing, atrial contribution was necessary to achieve the desired hemodynamic benefit. A permanent DDDR pacemaker was implanted with satisfactory clinical results.     

Extrathoracic Metastatic Thymoma A Case Report

A case of malignant thymoma who developed an extrathoracic metastatic lesion in the lumbar vertebra three years later, is presented. Radiotherapy can be used effectively in the local control of this disease as well as in the metastatic lesions.     

EFFECT OF ACUTE AND CHRONIC NEUROLEPTIC THERAPY ON SERUM PROLACTIN LEVELS IN MEN AND WOMEN OF DIFFERENT AGE GROUPS

A single fasting level of serum prolactin was measured in each of sixty control subjects and eighty-three psychiatric patients of both sexes who had been on neuroleptic therapy for 2-4 weeks (acute treatment) or at least 5 years (chronic treatment) and who were aged either 17-45 or 48-85 years. All groups of patients had significantly higher mean prolactin levels than controls. Gender, age group of women, and exposure to acute or chronic treatment were significant variables determining the magnitude of neuroleptic-induced elevation of prolactin. In some of the groups, dose, duration of chronic therapy, and concomitant administration of anticholinergic drugs also influenced prolactin levels. Whereas all acutely treated women had prolactin values above the control range, one out of twelve (8.3%) of the women aged 17-45 years and six out of fourteen (42.9%) of the women aged 48-85 years who were under chronic treatment had normal values. Normal prolactin levels were also found in five out of sixteen (31.2%) of the acutely treated and nine out of twenty-four (37.5%) of the chronically treated men aged 17-85 years.     

Pathways to Blood Coagulation Product I Formation

The basic reagent used was an eluate obtained from barium sulfate usedto adsorb various sera. When this eluate was prepared from normal rabbitserum, it responded to treatment with coagulants from adsorbed plasma,with Stypven, or with 25 per cent sodium citrate to give products withsimilar if not identical properties. With each preparation a stable complexformed with cephalin which withstood washing, was relatively heat-stable,was inactivated by adsorbed serum, and which required factor V for optimalprothrombin conversion. In eluates prepared from human serum, normalactivation occurred in the absence of factor IX, but was defective in theabsence of factor X. A preparation of factor X purified by DEAE cellulosechromatography was activated by 25 per cent sodium citrate. It is suggestedthat product I, the product of Stypven activation, and autoprothrombin Crepresent similar or identical reagents; it is further suggested that factor Xis their common precursor.

Submitted on November 7, 1962 Accepted on January 23, 1963     

Short‐ and Long‐Term Prognostic Value of the TIMI Risk Score after Primary Percutaneous Coronary Intervention for ST‐segment Elevation Myocardial Infarction

Objectives

We investigated the short‐ and long‐term predictive value of the TIMI risk score regarding mortality for patients treated with primary percutaneous coronary intervention (PPCI) for ST‐elevation myocardial infarction (STEMI).

Background

Data on the long‐term predictive value of the TIMI risk score is sparse.

Methods

We used data from 3,609 STEMI patients undergoing PPCI in a high‐volume PCI center in The Netherlands. Cumulative event rates according to TIMI score variables were estimated with the Kaplan‐Meier method and compared with the log‐rank test. The original TIMI risk score was modified based on the availability of the data in the single center registry.

Results

Higher TIMI scores were associated with significantly higher mortality at short‐ and long‐term follow‐up (P < 0.001 for both). Age and Killip Class IV at presentation were significant predictors for both short‐ and long‐term mortality. Patients with an anterior MI, heart frequence >100 beats per minute, or systolic blood pressure <100 mmHG had a worse short‐term prognosis compared to those who had not. However, long‐term mortality was nonsignificantly different. The presence of a history of diabetes/hypertension and weight had only long‐term prognostic value. Time to PPCI did not have any prognostic value.

Conclusions

Our current report shows that the TIMI risk score has both short‐ and long‐term discriminative value. The different variables contained in the TIMI risk score predict short‐term prognosis, others predominantly long‐term mortality, whereas some are predictive for both. (J Interven Cardiol 2013;26:8–13)

     

A FEASIBILITY STUDY OF GENE GUN MEDIATED IMMUNOTHERAPY FOR RENAL CELL CARCINOMA

PURPOSE: Gene modified autologous tumor cell vaccines have demonstrated a protective and therapeutic effect in murine tumor model systems. The majority of trials to date have used viral methods of gene transfer for vaccine construction. An alternative approach to transfer genes into tumor cells is to use the gene gun, which is a physical method of gene transfection that produces high levels of gene expression without viral agents. We establish the feasibility of generating cytokine secreting autologous renal tumor cell vaccines for use in gene therapy for metastatic renal cell carcinoma. MATERIALS AND METHODS: We obtained 1 cm3 tumor tissue from 12 patients undergoing resection of primary or metastatic renal cell carcinoma. The tumor was disaggregated and placed in culture. The phenotype of the primary renal cell lines was established by microscopy and immunohistochemistry. The 1x10(7) lethally irradiated tumor cells were transfected with plasmid deoxyribonucleic acid containing the human (h) granulocyte-macrophage colony-stimulating factor (GM-CSF) gene under control of a cytomegalovirus promoter using the gene gun. The hGM-CSF production was assayed by enzyme-linked immunosorbent assay in the cell culture media 24 hours after transfection. RESULTS: Of 12 tumor samples 8 grew rapidly to produce a mean of 1.8x10(8) cells after 4 to 5 passages in culture, which was sufficient to produce between 24 and 32 vaccines. Immunocytochemistry confirmed that all cultures were almost exclusively renal tumor cells. Gene gun mediated transfection of lethally irradiated tumor cells resulted in high levels of hGM-CSF production (mean 330 ng./10(6) cells per 24 hours). CONCLUSIONS: We have demonstrated the feasibility of producing cytokine secreting tumor cell vaccines from primary and metastatic human renal tumors, and plan to use this approach in phase I clinical trials of gene therapy for metastatic renal cell carcinoma.