Monitoring outcomes of services to children and youths with severe emotional disorders: an economical follow-up procedure for mental health and child care agencies.

Human services have been slow to develop and implement procedures for measuring the outcomes they are committed to achieve with clients. This is as true in child mental health and child care services as in other services. A method is described for getting follow-up data on youngsters with severe maladjustment (emotional disturbance, behavior disorder) at modest cost, yet high relevance. The method is part of the program monitoring and evaluation conducted routinely by the Pressley Ridge Schools and involves telephone interviews with each youngster and others during the summer of the year after the youngster's discharge from treatment. The process yields two kinds of reports with different functions: quantitative summaries of data and individual narratives that sketch each youngster's experience. The method, developed over eight years, has had favorable effects on the agency's services.

[Progressive cytomegalovirus encephalitis in successful ganciclovir therapy of cytomegalovirus retinitis in an AIDS patient]. / Progrediente Zytomegalie-Enzephalitis unter erfolgreicher Ganciclovir-Therapie einer Zytomegalie-Retinitis bei einem AIDS-Patienten.

We describe a case of an HIV-infected intravenous drug-abuser who died of progressive cytomegalovirus encephalitis despite successful treatment of cytomegalovirus retinitis with ganciclovir. On autopsy, complete remission of retinitis and widespread cytomegalovirus-encephalitis could be demonstrated. Therapeutic failure therefore seems attributable to insufficient CNS-distribution of ganciclovir rather than to ganciclovir-resistant cytomegalovirus strains.

[A case of AIDS-associated histoplasmosis in Germany]. / Ein Fall von AIDS-assoziierter Histoplasmose in Deutschland.

In a thirty-year-old patient with AIDS the diagnosis of disseminated histoplasmosis was established via biopsy and culture. The patient had grown up in Argentina, where histoplasmosis is endemic. He had not been in an endemic region during the last two years anteceding the manifestation of systemic histoplasmosis. Accordingly, in patients with a progressive immunodeficiency syndrome, reactivation of a former (possibly inapparent) infection with Histoplasma capsulatum must be considered. Therapy with Amphotericin B lead to a remarkable improvement of clinical, laboratory and sonographic findings. Due to the fact that total eradication of H. capsulatum from the infected host cannot be achieved with any known drug regimen, a life-long follow-up therapy was begun. The patient showed no signs of relapse after a follow-up of 7 months.

Lung tumour cell lines synthesizing peptide hormones established from tumours of four histological types: characterization of the cell lines and analysis of their peptide hormone production.

Thirty permanent and more than 60 primary tumour cell lines were established from pleural and pericardial exudates or wedge biopsies from human bronchial carcinoma. The permanent cell lines have their origin in 6 small cell, 5 large cell, 9 squamous and 5 adeno carcinomas of the lung. Tumour cells were purified from non tumour cells by direct cloning in fluid cultures or by soft agar cloning. In vitro secretion of ACTH, bombesin, calcitonin, and neurotensin was demonstrated for lung tumour cells belonging to the four major histological types. Cell suspensions of peptide hormone secreting permanent cell cultures were grown to solid tumours after xenotransplantation into nude mice. Comparative ultrastructural examination of the primary tumour and of cells grown in tissue culture and in xenografts demonstrated the preservation of most tumour type specific structural criteria in the ex vivo/in vitro systems. The present data show that not only tumour cells from small cell carcinoma but also from other histological types are capable of synthesizing a broad spectrum of immunoreactive peptide hormones. This result might be interpreted as indicating a common expression of hormone biosynthesis and secretion by all lung tumours.

Demonstration of immunoreactive calcitonin in sera and tissues of lung cancer patients.

In sera of 194 patients with lung carcinoma, calcitonin was estimated by radioimmunoassay with an antibody against human calcitonin. Increased levels of calcitonin-immunoreactive protein were found in 57% of the patients with small cell carcinoma, in 10% of the patients with squamous carcinoma and in only 2 patients with large cell carcinoma. In patients with small cell carcinoma, serial determinations of calcitonin were accomplished during therapy. Significantly decreased calcitonin levels were found in patients who responded to therapy with cytostatics and X-ray. Increased calcitonin levels were measured from 1 to 2 months before clinical symptoms of a relapse were detectable. Investigations on the biochemical nature of this calcitonin-immunoreactive protein were made on both serum of lung cancer patients and tumor tissue. Evidence for the production of calcitonin-immunoreactive protein directly by the tumor was given by immune histology and by determinations of calcitonin in tumor tissue. Three protein fractions, which were immunoreactive with anti-human calcitonin, with molecular weights of about 100,000, 48,000 and 20,000, were separated by gel filtration. The two higher molecular weight fractions were degraded to molecular weights of about 17,000 and about 3400--the molecular weight of physiological calcitonin--by incubation with sodium dodecyl sulphate under reducing conditions. These results led to the conclusion that it may be possible to characterize a tumor-specific calcitonin precursor molecule; in addition to its use in monitoring therapy it may be useful in the differential diagnosis of small cell carcinoma.

Purification by affinity chromatography of 2,4-dienoyl-CoA reductases from bovine liver and Escherichia coli.

1. Dye-ligand chromatography using immobilized Cibacron blue F3GA (blue Sepharose CL-6B) and Procion red HE3B (Matrex gel red A) as matrices and general ligand chromatography employing immobilized 2',5'-ADP (2',5'-ADP-Sepharose 4B) and immobilized 3',5'-ADP (3',5'-ADP-Agarose) were employed for purification of NADPH-dependent 2-enoyl-CoA reductase and 2,4-dienoyl-CoA reductase from bovine liver (formerly called 4-enoyl-CoA reductase [Kunau, W. H. and Dommes, P. (1978) Eur. J. Biochem. 91, 533-544], as well as 2,4-dienoyl-CoA reductase from Escherichia coli. 2. The NADPH-dependent 2-enoyl-CoA reductase from bovine liver mitochondria was separated from 2,4-dienoyl-CoA reductase by dye-ligand chromatography (Matrex gel red A/KCl gradient) as well as by general ligand affinity chromatography (2',5'-ADP-Sepharose 4B/NADP gradient). The enzyme was obtained in a highly purified form. 3. The NADPH-dependent 2,4-dienoyl-CoA reductase from bovine liver mitochondria was purified to homogeneity using blue Sepharose CL-6B, Matrex gel red A, and 2',5'-ADP-Sepharose 4B chromatography. 4. The bacterial 2,4-dienoyl-CoA reductase was completely purified by ion-exchange chromatography on DEAE-cellulose followed by a single affinity chromatography step employing 2',5'-ADP-Sepharose 4B and biospecific elution from the column with a substrate, trans,trans-2,4-decadienoyl-CoA. 5. The application of dye-ligand and general ligand affinity chromatography for purification of NADPH-dependent 2,4-dienoyl-CoA reductases taking part in the beta-oxidation of unsaturated fatty acids is discussed. It is concluded that making use of coenzyme specificity for binding and substrate specificity for elution is essential for obtaining homogeneous enzyme preparations.

[Antidiuretic hormone in patients with bronchial carcinoma (author's transl)]. / Antidiuretisches Hormon bei Patienten mit Bronchialkarzinom.

Antidiuretic hormone (ADH) was determined by radioimmunoassay in 139 patients with bronchial carcinoma. Serum ADH levels, compared with a control group, were increased in 30% of patients with small-cell and 21% of patients with large-cell bronchial carcinoma. Patients with squamous carcinoma or adenocarcinoma had normal ADH values. There was no correlation between serum ADH levels and stage of tumour. Serial ADH measurements during chemotherapy provided good correlation between ADH and response to treatment. ADH was also demonstrable by immunohistology in the tumour cells of one patient with increased serum levels.