Preparation of pentachlorophenol derivatives and development of a microparticle-based on-site immunoassay for the detection of PCP in soil samples.

Pentachlorophenol (PCP) is used as a herbicide in agriculture and as an insecticide for termite control. Because of the apparent hazard associated with its usage, there is a need for an efficient and economic on-site screening method. A 5-min on-site test has been developed for the detection of PCP based on the OnTrak format, a successful Roche on-site test format for drugs of abuse, utilizing the principle of latex agglutination immunoassay. The test detects 1 ppm of PCP in soil samples.

Achieving and sustaining full employment.

Human rights and public health considerations provide strong support for policies that maximize employment. Ample historical and conceptual evidence supports the feasibility of full employment policies. New factors affecting the labor force, the rate of technological change, and the globalization of economic activity require appropriate policies--international as well as national--but do not invalidate the ability of modern states to apply the measures needed. Among these the most important include: (I) systematic reduction in working time with no loss of income, (2) active labor market policies, (3) use of fiscal and monetary measures to sustain the needed level of aggregate demand, (4) restoration of equal bargaining power between labor and capital, (5) social investment in neglected and outmoded infrastructure, (6) accountability of corporations for decisions to shift or reduce capital investment, (7) major reductions in military spending, to be replaced by socially needed and economically productive expenditures, (8) direct public sector job creation, (9) reform of monetary policy to restore emphasis on minimizing unemployment and promoting full employment. None are without precedent in modern economies. The obstacles are ideological and political. To overcome them will require intellectual clarity and effective advocacy.

Chronic post thoracotomy pain.

Chronic post-thoracotomy pain (CPP) is a vexing clinical problem whose management has received scant attention. In order to identify the risk factors associated with CPP and determine the optimal treatment, the records of 238 consecutive patients who underwent thoracotomy were reviewed. CPP was defined as discomfort requiring the regular administration of analgesics that continued more than three months following surgery. CPP was present in 25 (11%) patients: 10/20 (50%) chest wall resections, 5/25 (20%) pleurectomies, 10/193 (5%) pulmonary resections. Among the 23 patients who required preoperative narcotics, 12 (52%) developed CPP. Improved pain control and decreased narcotic use was achieved via the administration of nonsteroidal anti-inflammatory medication and tricyclic anti-depressants. In addition, 10/25 patients required 11 pain procedures: trigger-point injection, intercostal blocks, injections of epidural steroids, stellate ganglion block. Recurrent pain occurred in 20 patients following initial control. All were found to have tumor regrowth. We conclude that CPP occurs more commonly following chest-wall resection and pleurectomy, and that preoperative narcotic use is a predictor of CPP. Worsening pain following initial relief should prompt a vigorous search for recurrent cancer.

Supportive care in oncology.

Pain management, nutritional support, and psychosocial support are fundamental services that enhance patients' ability to cope with their cancer and its therapy. The common goal of symptom prevention mandates that each of these supportive services be provided to all patients throughout their cancer experience. Comprehensive cancer pain management begins with identifying the origin of all of the patient's pains and treating each one specifically. Pain prevention can be achieved through around-the-clock opioid administration with as-needed supplements for breakthrough pain and dose titration. Common narcotic side effects such as constipation and nausea also must be prevented. Successful opioid analgesia requires that patient and family concerns regarding addiction and tolerance be dispelled at the outset. Cancer pain prevention can be further optimized with the use of appropriate coanalgesics in response to the pathophysiology of the patient's pains. Cognitive and behavioral therapies may also be useful adjuncts to reduce both pain and suffering. Procedure-oriented pain control should be considered when systemic pharmacologic therapy does not provide adequate pain relief or is associated with intolerable side effects. The only absolute contraindications for pain-relieving procedures are untreatable coagulopathy and a decrease in mental status not related to medical pain management. Useful neurodestructive techniques include radiofrequency lesioning, cryoanalgesia, and chemical neurolysis with agents such as phenol, alcohol, and hypertonic saline. The most beneficial pain-relieving procedures and percutaneous cordotomy, spinal narcotics, celiac and hypogastric plexus ablation, spinal neurolysis, and epidural injection of steroids and hypertonic saline. Procedure selection depends on the cause of the pain and the patient's prognosis. Common indications for pain-relieving procedures include unilateral pain below the shoulder, upper abdominal visceral pains, pelvic visceral pain, perineal pain, vertebral body metastasis, discogenic pain, and spinal stenosis. As results of well-conducted scientific trials begin to appear in the literature, the indications for these procedures will be better understood, resulting in their more appropriate use. Principles of nutritional support in patients with cancer include an awareness of the problem of malnutrition and its impact on performance status, quality of life, prognosis, and treatment; identification of those patients at risk; prophylactic versus therapeutic intervention; and analysis and management of the specific impediment(s) to adequate nutrient intake and absorption. The primary goals for nutritional support in cancer patients are prevention of weight loss and maintenance of adequate protein status. Appreciation of practical issues of nutritional support will enable the practicing physician to achieve these goals using primarily oral nutrition options.(ABSTRACT TRUNCATED AT 400 WORDS)

Transdermal fentanyl: seeding trial in patients with chronic cancer pain.

In this study, 6 patients with pain from advanced cancer were enrolled in a multicenter, open-label seeding trial of transdermal fentanyl. Following equianalgesic dose conversion, transdermal fentanyl patches were applied every 3 days. Mean fentanyl dosage doubled by week 2 and tripled by week 4. Pain control improved in all patients. There were no significant changes in mood, constipation, nausea, sedation, daily activities, or interpersonal relationships from pretrial to posttrial analyses. Following the study period, 5 patients were monitored for a mean total of 55 days with a mean final fentanyl dose of 240 micrograms/hr. As part of a comprehensive cancer pain management program, transdermal fentanyl appears to be safe and effective, and should prove to be a useful addition to currently available opioid analgesics.

Degree of heterogeneity of binding specificities of antibodies to the phenylarsonate group that share a common idiotype.

We have investigated the microheterogeneity of hybridoma products (HP) expressing the major idiotype (CRIA) associated with A/J antibodies to the p-azophenylarsonate (Ar) hapten group. The properties investigated were affinity for a phenylarsonate derivative and the fine specificity of the combining sites of the various HP. The fine specificity was approached by measuring relative affinities for a series of related haptens. It was found that, although variations exist, there are strong similarities in affinities and fine specificities of the antigen-binding sites of CRI+A HP. The range of affinities for (p-azobenzenearsonic acid)-N-3H-acetyl-L-tyrosine was 0.41 x 10(6)-2.2 x 10(6) M-1. In all cases the addition of a second ring structure (benzene or histidine) and an azo group greatly increased the binding affinity. Some differences in fine specificity among the HP were seen with respect to affinities for o-arsanilate or the arsanilate derivative of histidine. However, the two HP which are the strongest inhibitors in the conventional assay for CRIA were virtually identical to one another and to induced A/J anti-Ar antibodies in their fine specificities. Together with previous data on amino acid sequences and serological properties, the results indicate that, despite their microheterogeneity, members of the CRIA family are closely related in structure and hapten-binding specificity.

Voice pitch as an aid to lipreading.

The totally deafened adult, unable to make use of a hearing aid, has no alternative to lipreading for everyday communication. Lipreading, however, is no substitute for hearing speech. Many lipreaders have great difficulty in ideal conditions and even the best lipreaders find the task demanding and tiring. Prosthetic attempts to substitute for lost hearing have centred on three distinct types of intervention, visual, tactile, and electrocochlear. As none of these is likely to yield a good understanding of a speech independent of lipreading in the near future, we have attempted to isolate relatively simple patterns of stimulation that, although not intelligible in themselves, well aid lipreading. From this point of view, the fundamental frequency or 'pitch' of the voice is the most important pattern element because if provides both segmental and suprasegmental information and is practically invisible. It thus complements the visual information already available on the face. As we show here, with the voice pitch presented acoustically, normal listeners can lipread a speaker reading continuous text at up to two and a half times the rate possible on the basis of lipreading alone. The pitch signal by itself, of course, is completely unintelligible. Although our work is primarily concerned with methods of electrical stimulation of the cochlea, it has implications for other sensory substitution techniques, the design of special purpose hearing aids and current theories of speech perception.

External electrical stimulation of the cochlea: clinical, psychophysical, speech-perceptual and histological findings.

Our progress towards the development of a particular form of cochlear implant for the totally deaf is described. A single channel stimulation at the round window or promontory is used. This involves a minimum of surgical intervention and infective risk, preserves the possibility of remission and allows the application of later developments. The signal used for stimulation is designed to be matched both to the deaf lip-reader's needs and to his new, restricted, auditory ability. This is done by concentrating on the acoustic pattern components of speech which carry intonation and voiced-voiceless information. Surgical electrophysical, psychoacoustic and speech perceptual aspects of our work with twelve patients are described. The tests involve responses, for example, relating to: threshold for sinusoids; frequency difference limens; periodic -aperiodic discrimination; stress placement; and consonant labelling using combined visual and electrical inputs. Relatively extensive measurements were made with six patients. Significant individual differences were found and the sets of responses provide an essential basis for an appraisal of the potential usefulness of our work to the individual patient. Possible reasons for the individual differences are discussed. A brief indication is given of the techniques which we have developed for the future speech training and speech production evaluation of patients with electro-cochlear voice monitoring. The final section of our paper mentions our histological investigation of the effects of this type of stimulation in the guinea pig.

Nephrotoxicity of paraquat in man.

Renal function studies were performed in three cases of paraquat poisoning. Acute renal failure was observed in all three cases. Glomerular filtration rate improved for two patients who survived three weeks, illustrating the reversible nature of paraquat-induced acute renal failure. A mild to moderate transient proteinuria was observed during the first and second weeks following paraquat ingestion. Renal glucosuria, marked amino aciduria, and increased fractional excretion of phosphorus, sodium, and uric acid were observed. These findings, which have not been previously described in man, are indicative of proximal tubular dysfunction and parallel observations previously made in experimental animals.

Serum ferritin level. Determinant of iron requirement in hemodialysis patients.

Seventeen patients without renal failure and 14 patients receiving long-term hemodialysis were studied. Serum and bone marrow ferritin determinations were made at the time of bone marrow aspiration. A good correlation was found between serum ferritin levels and bone marrow iron stores, as well as between bone marrow ferritin levels and iron stores. Serum ferritin determinations appear to give an accurate estimation of bone marrow iron stores, thereby providing a reliable guide for iron replacement therapy and reducing the need for repeated bone marrow aspirations. Serum ferritin levels of less than 105 ng/ml suggest decreased iron stores, and values greater than 120 ng/ml indicate adequate or increased iron stores. Preliminary data also suggest that bone marrow ferritin determinations may be useful in quantitating bone marrow iron stores.

Use of expanded polytetrafluoroethylene grafts for vascular access in hemodialysis: laboratory and clinical evaluation.

Vascular access for chronic hemodialysis has evolved considerably over the past 10 years with development of vascular substitutes. The bovine heterograft is the choice of most dialysis centers when a subcutaneous conduit is needed in lieu of an in situ arteriovenous fistula. Bovine grafts have solved some problems, but further improvement in blood access prostheses is needed. Polytetrafluoroethylene (PTFE) grafts were evaluated in a laboratory and clinical study. In animals, PTFE proved to be satisfactory for fistula construction based on patency, incorporation into tissue, and ease of puncture. Ten patients underwent 11 vascular access procedures using PTFE grafts as a conduit. There were no technical operative complications. One graft was occluded by extravasation during dialysis and flow could not be restored. Otherwise, all grafts are patent 9 to 18 months postoperatively. Grafts of 8.0 mm in diameter have not given desirable flow rates, whereas 6.0 mm grafts have. Prolonged bleeding from puncture has been a problem in some cases. Otherwise, PTFE appears to be a satisfactory conduit for hemodialysis vascular access.

Hemodialysis in treatment of acute chloral hydrate poisoning.

A young pregnant (32 weeks' gestation) woman with severe chloral hydrate intoxication was treated with hemodialysis. This resulted in dramatic improvement of her profound central nervous system depression, protracted ventricular arrhythmias, fetal distress, and resumption of spontaneous respiration. The blood concentration of trichloroethanol was measured hourly during the dialysis and its dialysance was calculated. This experience suggests that hemodialysis may be a useful adjunct in the treatment of severe chloral hydrate poisoning.

Maintenance hemodialysis in myeloma kidney disease.

Maintenance hemodialysis and chemotherapeutic agents were used in the treatment of seven patients with end-stage myeloma kidney disease. Results indicate that with the use of such therapy life can be prolonged substantially. It appears that patients with myeloma-with or without serious extrarenal complications-are suitable candidates for maintenance hemodialysis and should not be denied the treatment even in the face of systemic neoplasm.