Implementing touch-screen technology to enhance recognition of distress.

OBJECTIVE: The University of California, San Diego, Moores Cancer Center implemented a systematic approach for patients to communicate with their health-care team in real-time regarding psychosocial problem-related distress using touch-screen technology. The purpose of this report is to describe our experience in implementing touch-screen problem-related distress screening as the standard of care for all outpatients in a health-care setting. Although early identification of distress has recently gained wide attention, the practical issues of implementing psychosocial screening with and without the use of technology have not been fully addressed or investigated. METHODS: 'The How Can We Help You and Your Family?' screening instrument was used to identify and address patient problem-related distress for clinical services, program development, research and education. Using a HIPPA-compliant approach, the touch-screen technology also helped to identify patients interested in clinical trials and additional support services. RESULTS: We found that the biggest barrier to implementing this technology was the attitude of the front desk staff (i.e. schedulers, clerks, administrative staff) who felt that the touch-screen would be burdensome. Our experience suggested that it was essential to actively involve these personnel from the beginning of the planning process. As specifically acknowledged in the recent 2007 Institute of Medicine report (Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. The National Academies Press: Washington, DC, 2007), use of this computerized version of the screening instrument was able to bridge the gap between the detection of problem-related distress and referrals for assessment or treatment. CONCLUSION: We found that it is feasible to implement a computerized problem-related distress screening program in a comprehensive cancer center.

Reduction of pesticide residues on produce by rinsing.

In 1997 this laboratory initiated a research program with the objective of examining the effect that rinsing of produce with tap water would have on pesticide residues. Samples were obtained from local markets and/or grown at our experimental farm. Because approximately 35% of produce from retail sources contains pesticide residues, growing and treating produce at an experimental farm had the advantage that all such samples contain pesticide residues. Pesticides were applied under normal field conditions to a variety of food crops and the vegetation was allowed to undergo natural weathering prior to harvest. The resulting samples contained field-incurred or "field-fortified" residues. This experimental design was employed to mimic as closely as possible real world samples. Crops were treated, harvested, and divided into equal subsamples. One subsample was processed unwashed, whereas the other was rinsed under tap water. The extraction and analysis method used was a multi-residue method developed in our laboratory. Twelve pesticides were included in this study: the fungicides captan, chlorothalonil, iprodione, and vinclozolin; and the insecticides endosulfan, permethrin, methoxychlor, malathion, diazinon, chlorpyrifos, bifenthrin, and DDE (a soil metabolite of DDT). Statistical analysis of the data using the Wilcoxon signed-rank test showed that rinsing removed residues for nine of the twelve pesticides studied. Residues of vinclozolin, bifenthrin, and chlorpyrifos were not reduced. The rinsability of a pesticide is not correlated with its water solubility.

A new autosomal dominant disorder of pyogenic sterile arthritis, pyoderma gangrenosum, and acne: PAPA syndrome.

OBJECTIVE: To describe a multigenerational family with transmission of an autosomal dominant disorder characterized by pyogenic arthritis, pyoderma gangrenosum, and severe cystic acne. MATERIAL AND METHODS: We present a detailed case report of a 39-year-old man with arthritic changes in several joints, pyoderma gangrenosum, and cystic acne. Several relatives from three generations of his family underwent clinical and genetic investigations. The findings in this kindred are reported. RESULTS: Ten affected family members in three generations manifested variable expression of a pauciarticular, nonaxial, destructive, corticosteroid-responsive arthritis that began in childhood; pyoderma gangrenosum; and severe cystic acne in adolescence and beyond. Other less commonly associated features included adult-onset insulin-dependent diabetes mellitus, proteinuria, abscess formation at the site of parenteral injections, and cytopenias attributable to sulfonamide medications. Laboratory evaluation was nondiagnostic. Genetic studies excluded linkage to the major histocompatibility locus. CONCLUSION: The acronym of PAPA syndrome (pyogenic sterile arthritis, pyoderma gangrenosum, and acne) is suggested for this newly recognized pleiotropic autosomal dominant disorder. The nature of the genetic alteration in PAPA syndrome is unknown.

Systemic gadolinium toxicity in patients with renal insufficiency and renal failure: retrospective analysis of an initial experience.

OBJECTIVE: To study the possible deleterious systemic effects of gadolinium in patients with impaired renal function. DESIGN: We retrospectively analyzed the routine laboratory data and clinical course of patients who had undergone a gadolinium-enhanced magnetic resonance imaging (MRI) examination of the brain and spine and had evidence of impaired glomerular filtration. MATERIAL AND METHODS: Between October 1988 and October 1992, 15,830 patients underwent gadolinium-enhanced MRI at our institution, 151 of whom had a serum creatinine value of more than 2 mg/dL. The clinical records of these 151 patients were thoroughly examined for the period from 3 days before to 30 days after the gadolinium-enhanced MRI examination. All data were analyzed in an attempt to detect any adverse events that could be related to free gadolinium as a result of dissociation from the chelating agent due to prolonged elimination times (that is, increased serum creatinine concentrations). In addition, we calculated the 90-day mortality rate for both the study group and a matched control population of 80 patients who had undergone MRI of the brain and spine before gadolinium was available. RESULTS: The overall incidence of adverse events in the study group was 3.6%. No event was severe or life threatening--nausea and rash occurred in two patients each, and seizure and headache occurred in one patient each. These findings were not significantly different from those in previous studies performed in populations with normal elimination times. Moreover, no significant difference was noted in the 90-day mortality rate (14.6% of the study group) in comparison with that in the control group (13.8%). CONCLUSION: On the basis of this initial retrospective analysis, we were unable to detect any clinical deleterious effects of administration of gadolinium for MRI examination in patients with impaired renal function. Further investigation with prospective studies is needed to confirm these initial retrospective findings.

Hepatic adenomatosis.

This case report describes a 41-year-old woman with hepatic adenomatosis (multiple hepatic adenomas) associated with acute hemorrhage. She had no history of oral contraceptive use or corticosteroid therapy. Ultrasonography showed multiple masses in the right lobe of the liver. The clinical associations and potential complications of hepatocellular adenomas are discussed, and the histologic characteristics are provided. Their typical appearance on computed tomography, ultrasonography, magnetic resonance imaging, and nuclear scintigraphy is described. The differential diagnosis of hepatic adenomatosis and multiple solid liver masses is discussed.

Identification and characterization of a partial cDNA expressing interleukin-1-like activity in keratinocytes.

A partial cDNA has been isolated from the human keratinocyte cell line COLO-16 which is distinct from either IL-1 alpha or beta and encodes a protein which displays some of the biological properties associated with IL-1. The 720 bp partial cDNA hybridized on Northern blots of COLO-16 mRNA to a 1.6 kbp message of low abundance. Expression of the partial cDNA in COS-1 cells resulted in activity in three IL-1 assays: thymocyte co-stimulation, D10.G4.1 T-cell stimulation and fibroblast proliferation. Antisera generated against synthetic peptides based on inferred protein sequence from the cDNA reacted with a 20 kDa and 30 kDa species in both the COLO-16 cell line and PMA-stimulated normal human keratinocytes. These novel species were also present in PMA-stimulated and unstimulated human dermal fibroblasts and human T-cell lines.

Expression of interleukin-1 beta in a human keratinocyte cell line.

The human keratinocyte cell line COLO-16 expresses mRNA homologous to human IL-1 alpha and IL-beta (transcript sizes 2.3 and 1.6 kb, respectively). A 1.2 kbp cDNA was selected with a human IL-1 beta probe from a lambda gt11 library constructed using poly A+ RNA from COLO-16 cells. Sequence analysis revealed that this cDNA was nearly identical to the 3' 1.2 kb of human monocyte IL-1 beta. When this cDNA was expressed in COS cells using a mammalian expression vector, IL-1 activity was detected in the cell conditioned supernatants using assays for D10-T-cell, thymocyte and fibroblast proliferation. Western analysis of lysates from COS cells transfected with this clone revealed the presence of a -17 kDa protein which reacted with antisera to human IL-1 beta. This protein was the same size as the processed form of IL-1 beta present in COLO-16 cells suggesting that this cDNA encodes the mature form of IL-1 beta. COLO-16 cells contain proteins of -30 kDa and 17 kDa which are immunoreactive with specific antisera for human IL-1 alpha and human IL-1 beta. Despite the presence of four-fold greater amounts of immunoreactive IL-1 beta protein than IL-1 alpha in cell lysates, all the IL-1 activity in the lysate could be neutralized by antisera to IL-1 alpha. IL-1 beta comprised only 25% of the IL-1 activity in the cell-conditioned media, all remaining activity was neutralized by antisera to IL-1 alpha. Whereas IL-1 alpha protein in both cell lysates and conditioned supernatants was predominantly in the processed -17 kDa form, IL-1 beta proteins were primarily of the processed and inactive 30kDa species. This apparent inability of keratinocytes to process IL-1 beta may explain our observations that the IL-1 activity secreted by COLO-16 cells is principally due to IL-1 alpha.

Biology and molecular biology of epidermal cell-derived thymocyte activating factor.

ETAF/IL-1 has a multiplicity of divergent biological effects: enhancement of thymocyte proliferation, stimulation of cells in the hypothalamus to mediate fever, leukocyte chemotaxis, stimulation of hepatic synthesis of acute-phase proteins, augmentation of IL-2 production and keratinocyte proliferation. Until recently, it has not been possible to determine whether these divergent activities are mediated by closely related cytokines or separate cytokines. Now with the identification of IL-1 alpha, IL-1 beta and IL-1k from keratinocytes, these studies will become possible. In either case, it is likely that ETAF/IL-1 plays an important role in local cutaneous and systemic inflammatory and immunological events.