Community health assessment tool: a patterns approach to data collection and diagnosis.

Creation of an assessment tool to apply Gordon's functional patterns to the community as a client was a rewarding and stimulating project. Through use of the CHAT, students developed an appreciation of the complexity and inter-relationship of numerous aspects of the community. They completed the nursing process by developing appropriate nursing diagnoses, and planning, implementing, and evaluating a health promotion project. As the students continue to use this tool in the health promotion course, the diagnoses which they generate are being collected. From this accumulated input the plan is to compile a list of common diagnoses which are appropriate to use when the community is the client.     

Flat adenomas in a colon cancer-prone kindred

We describe new pathologic findings in a hereditary nonpolyposis colorectal cancer family. Affected family members developed multiple small adenomas with right-sided predominance; many adenomas had an unusual appearance featuring slightly elevated lesions with adenomatous changes confined to the upper regions of the colonic crypts. We have adopted the previously established term "flat adenoma" for these lesions. This phenotype may be a morphologic marker for at least one subset of hereditary nonpolyposis colorectal cancer.     

MTSEA potentiates 5-HT3 receptors containing the nicotinic alpha4 subunit

In order to study the subunit composition of 5-HT3 receptors (5-HT3R), we report that (2-aminoethyl)methanethiosulfonate (MTSEA) can enhance the function of both nicotinic ACh receptors (nAChRs) comprised of alpha4/beta2 subunits, and heteromeric channels assembled from serotonin 5-HT3R and alpha4 nAChR subunits. MTSEA has no effect on homomeric 5-HT3 receptor channels.     

Sources of murine macrophage colony-stimulating factor that also contain growth factors for primitive macrophage progenitor cells

A new growth factor (synergistic factor, SF) has recently been described, which, in combination with a macrophage CSF source, is able to stimulate the proliferation of primitive high-proliferative-potential macrophage-progenitor cells (HPP-CFC) in mouse bone marrow in culture. It has been found that the addition of supraoptimal amounts of the crude CSF sources, extracts of pregnant mouse uterus and embryo, media conditioned by L cells or the mouse mammary tumor cell line (EMT6), stimulated the proliferation of HPP-CFC in the absence of any added SF. These preparations thus appear to contain a factor with similar biological properties to those of SF. This conclusion is supported by the results obtained from Sephacryl S200 chromatography of these three CSF sources, which indicate that in all three cases fractions with apparent molecular weight (MW) greater than 68,000 contained the major portion of the CSF-1 activity, whereas fractions with MW less than 68,000 contained the SF-like activity, together with minor amounts of CSF-1 activity.     

Recognition and treatment of patients with hereditary nonpolyposis colon cancer (Lynch syndromes I and II).

Primary genetic factors are etiologic in at least 5-10% of patients with colon cancer. The polyposis syndromes (FPC) are easily identified examples because of the spectacular number of polyps. The hereditary nonpolyposis syndromes (HNPCC), although five times more common than FPC, are usually not recognized because they do not have such a distinctive clinical, premonitory genetic marker. Colorectal cancer expression was surveyed in 10 extended, thoroughly documented HNPCC kindreds. One hundred sixteen patients were found to have 183 colorectal cancers. Despite the striking family history, less than 5% were correctly treated by subtotal colectomy. This provided a unique opportunity to study the natural history. Five findings differed significantly (p less than 0.05) from patients with sporadic colon cancer: (1) mean age of initial colon cancer diagnosed was 45.6 years; (2) 69.1% of first colon cancers were located proximal to the splenic flexure of the colon; (3) 18.1% had synchronous colon cancer; (4) 24.2% had metachronous colon cancer develop with life table analysis showing the risk for a metachronous lesion at 10 years to be 40%; and (5) only 23.3% of cancers were located in the sigmoid colon or rectum. Based on this data, it is recommended that the family history of all patients with a newly diagnosed colon cancer be evaluated for evidence of this syndrome. If an autosomal dominant inheritance pattern emerges, an in-depth genetic investigation is indicated. When HNPCC is confirmed, the following recommendations apply: a subtotal abdominal colectomy is indicated at the time of the initial colon cancer because of the risk of synchronous and metachronous lesions. The rectum should be spared in favor of careful lifetime surveillance because of the proclivity for proximal colon cancer involvement. As yet unaffected members of a newly diagnosed HNPCC kindred who are in the "direct genetic line" should be cautioned that they are at 50% risk and must begin an intensive surveillance program beginning in the third decade with careful attention to the right colon. Patients from newly diagnosed HNPCC families who have had a previous conventional colectomy for colon cancer should, at the very least, enter an intensive surveillance program; a prophylactic completion subtotal colectomy should be considered for patients who are less than totally compliant.     

Detection of synergistic factor and interleukin-3 activity in the serum and ascites fluid of mice bearing the WEHI-3 tumour

Media conditioned (CM) by WEHI-3 cells (a myelomonocytic leukemia cell line) contains a number of haemopoietic growth factors, including synergistic factor (SF) and interleukin-3 (IL3). We have investigated the production of SF and IL3 in vivo in mice bearing the WEHI-3 tumour. SF and IL3 activity were detected in both the sera and ascites fluids of these mice. SF from the ascites fluid was partially purified by a four-step purification schedule consisting of ammonium sulphate fractionation, DEAE-cellulose, hydroxylapatite, and Sephadex G-100 chromatography. This purification sequence resulted in approximately a 250- and 187-fold purification of SF and IL3 respectively on the initial starting material with a yield of 13 and 9.7% respectively of the initial activity. At each stage of purification, the fractions containing SF co-purified with IL3 activity, further supporting our previous report that SF and IL3 are probably identical molecules. The characteristics of the in-vivo derived (sera and ascites fluid) activities were found to be similar to those of the factors produced in vitro in WEHI-3 cell conditioned media. These results support the conclusion that SF and IL3 are produced in vivo in WEHI-3 tumour bearing mice and are not in vitro artifacts.     

Protection of murine bone marrow by dexamethasone during cytotoxic chemotherapy

Corticosteroids have the ability to suppress the production of growth factors and cytokines and are thus implicated in the negative regulation of hematopoiesis. We have shown that the corticosteroids, prednisolone and dexamethasone, were able to effectively protect progenitor cells in four strains of mice against cell-cycle-specific antimetabolic chemotherapy agents. The highest levels of protection against 5-fluorouracil (FU; 200 mg/kg) were achieved when two or three intraperitoneal injections of dexamethasone were administered between - 7 and +3 hours at a dose of 7.5 mg/kg/injection (optimal dose) or by continuous infusion between -4 and +20 hours. This protective effect is manifested as an increase in the number of high proliferative potential colony-forming cells that survive in the bone marrow 3 days after treatment with FU from between 0.5% and 11% to between 10% and 34% of normal. The bone marrow progenitors and blood cell numbers return to normal from 3 to 5 days and 1 to 2 days earlier, respectively. Less dexamethasone than prednisolone is required to give an equivalent protective effect, which is consistent with their anti-inflammatory potency. These findings are further evidence of the negative regulatory role played by corticosteroids, and indicate that the treatment schedules of corticosteroids during cancer therapy need to be reexamined to obtain the maximum benefit from their use.     

In vivo effects of interleukin-1 alpha on regenerating mouse bone marrow myeloid colony-forming cells after treatment with 5-fluorouracil

Injection of a single dose of recombinant human interleukin-1 alpha (r-hu-IL-1 alpha) into mice 24 hr after 5-fluorouracil (FU) treatment resulted in an increased rate of recovery of three types of colony-forming cells (CFCs) in the bone marrow. Myeloid progenitors with high proliferative potential (responsive to CSF-1 + IL-3 + IL-1 alpha), low proliferative potential (responsive to CSF-1), megakaryocyte progenitors, and total nucleated cells per femur increased up to 5-fold, 7-fold, 3-fold, and 3-fold, respectively, in a dose related fashion compared with the control FU treated marrows. The kinetics of FU kill and recovery of these CFCs are shown.