FAMILY COMPLIANCE TO A TREATMENT PROGRAMME FOR ALCOHOLICS: A PROSPECTIVE STUDY OF PROGNOSTIC FACTORS

A total of 198 alcoholic subjects was recruited into a treatmentprogramme according to Hudolin's method. The programme includedthree steps: (1) presentation of the programme to the alcoholicfamily (four meetings); (2) a therapeutic community that metweekly over 4 months; and (3) attendance at an on-TreatmentAlcoholic Club located close to the family's home residence(weekly self-conducted meetings). Data on the families' complianceto the treatment programme were obtained in January 1993 andthe prognostic significance of 11 variables collected duringthe first step was determined by the proportional hazards regressionmodel. The cumulative proportion of family compliance after40 months was 36.4%, with similar drop-out rates at each ofthe three steps of the programme. The prognostic factor whichwas the major determinant of family compliance to treatmentwas the active presence of the whole family in the first step,while a good job performance was independently associated withfamily compliance, being a significant prognostic factor inthe second step of the programme. Alcohol abstinence was obtainedin 35.9% of the whole study group. This programme provided resultsfor alcohol abstinence which are comparable with methods thatrequire more expensive resources.     

Carcinoembryonic Antigen as a Monitor in Breast Cancer

ABSTRACT: Carcinoembryonic antigen (CEA) levels were serially determined in 125 patients with breast cancer in order to study the diagnostic and prognostic use of serum CEA levels before and/or after surgery and during treatment with hormonal and chemotherapy. Serum CEA levels were elevated in 15.5% of nonmetastatic patients. Carcinoembryonic antigen increased according to stage (TNM classification); and a direct relationship between positive CEA levels and subsequent recurrence was found. After a three-year postoperative interval a 50% survival rate was exhibited in CEA-positive patients vs an 88% survival rate in those patients found to be CEA negative. There is a definite correlation between the trend of serial CEA values and the response to therapy and the development of metastases despite the fact that metastases occurred in CEA-negative patients. Therefore CEA assay is a useful and simple adjuvant test of monitoring metastatic and nonmetastatic breast cancer.     

Clinical Evaluation of a Prototype Passive Fixation Dual Chamber Single Pass Lead For Dual Chamber ICD Systems

Dual chamber ICD systems use two separate leads for sensing. We developed and tested a new prototype of a single pass dual chamber passive fixation lead for dual chamber ICDs. Methods and Results: The prototype was a modification of the Guidant CPI Endotak DSP lead. The additional sensing electrode for the right atrium consisted of a side-mounted porous atrial ring electrode (AR). Atrial signals were recorded from the lead in patients during normal sinus rhythm (NSR), atrial fibrillation (AFib), and/or atrial flutter (AFl) with the AR in stable contact with the atrial wall or floating. During NSR, with the AR in contact with the atrial wall, an average P wave amplitude of 7.2 ± 1.5 mV (mean ± SD, n = 12) was measured. After induction of AFib/AFl, the single amplitude decreased to 3.6 ± 1.5 mV (n = 8) during AFib and 3.4 ± 1.7 mV (n = 9) during AFl. Amplitudes dropped between 53% and 75% when the AR lost atrial wall contact. The atrial pacing threshold was 1.0 ± 0.4 V (n = 16) when the AR was in contact with the atrial wall. Conclusions: In future dual chamber ICDs the signals from a passive fixation single pass lead could be used for atrial sensing and pacing as long as the sensing electrode for the right atrium remains in contact with the atrial wall. This system might lead to a simpler, less invasive implantation of dual chamber ICD systems.     

Endocervical tubal metaplasia and adenocarcinoma in situ: role of immunohistochemistry for carcinoembryonic antigen and vimentin in differential diagnosis

Eighteen cases of endocervical tubal metaplasia (tubal metaplasia) and 16 cases of adenocarcinoma in situ were reacted immunohistochemically for carcinoembryonic antigen (CEA) and vimentin. Whereas CEA was more frequently positive in adenocarcinoma in situ cases (63%) than in tubal metaplasia cases (39%), vimentin was not expressed in adenocarcinoma but was positive in 78% of cases of tubal metaplasia.     

OXIDATION OF TRYPTOPHAN TO OXINDOLYLALANINE BY DIMETHYL SULFOXIDE-HYDROCHLORIC ACID

Tryptophan is readily oxidized to oxindolylalanine (2-hydroxytryptophan) in good yield on treatment in acetic acid solution with a mixture of dimethyl sulfoxide (DMSO) and concentrated aqueous HCl at room temperature. Other sulfoxides can be used in combination with HCl; for example, methionine sulfoxide reacts with an equimolar amount of tryptophan to give high yields of methionine and oxindolylalanine. Methionine and cysteine are quantitatively oxidized by DMSO/HCl to methionine sulfoxide and cystine, respectively. The tryptophan containing peptides LRF (luteinizing hormone-releasing factor), somatostatin, valine-gramicidin A and ACTH^1–24were each treated with the DMSO/HCl reagent in acetic acid solution and the corresponding oxindolylalanine-derivatives isolated in over 90% yield after chromatography. The identity and purity of the derivatives were established on the basis of ultraviolet spectral characteristics and quantitative amino acid analysis of the oxindolylalanine content of acid hydrolyzates of the oxidized peptides with 3N-p-toluenesulfonic acid at 110° for 24 h. The results indicate that modification of tryptophan peptides with DMSO/HCl provides a useful procedure, which seems superior to previously used reagents. In addition, the method could be well applied to other indoles of biological and pharmacological interest.