Cancer metastases in the pituitary gland.

Metastases to the pituitary gland is a rare complication of systemic cancer in adults (does not practically occur in children). In 1857 L.Benjamin was the first who described a case of metastasis to the pituitary gland at autopsy of a patient with disseminated melanoma. Metastases in the pituitary gland are marked in 0,14-28,1% of all metastases to the brain in several series of autopsies. Many researchers consider that metastases in the pituitary gland are met in 1% of patients who underwent transsphenoidal surgery and 5% of autopsies.

A brief measure for the assessment of coping self-efficacy among alcohol and other drug users.

AIMS: To develop a reliable and valid brief measure of coping self-efficacy for substance users to serve the needs of clinicians and researchers who desire a global measure of a client's confidence across high-risk situations. The eight-item global measure of self-efficacy was derived from the Drug-Taking Confidence Questionnaire (DTCQ), a 50-item self-report measure of situation-specific coping self-efficacy applicable to alcohol and other drug users. DESIGN: The questionnaire was administered by trained staff to clients at intake to treatment. Items were selected using stepwise regression. Reliability and construct validity were assessed using alpha and correlation coefficients. SETTING: An addiction treatment facility in Toronto, Ontario. PARTICIPANTS: Seven hundred and thirteen English-speaking adults presenting for treatment with an alcohol or other drug problem. The sample was comprised of alcohol (344), cocaine (253), heroin (53), cannabis (43), other drug (20) users. MEASUREMENTS: The DTCQ: perceived difficulty quitting, motivation to quit and confidence in quitting; depression score (SCL-90-R); and motivation scores (SOCRATES-revised). FINDINGS: An eight-item version (DTCQ-8) accounted for 95% of the variance in the total DTCQ-50 scores and correlated 0.97 with the total DTCQ-50 score. Reliability and validity for the DTCQ-8 as a global indicator of coping self-efficacy was confirmed. CONCLUSIONS: Clinically, the DTCQ-8 is useful for the assessment and monitoring of confidence levels during treatment. The DTCQ-8 is a promising research tool for inclusion in outcome evaluation batteries that require a brief, reliable and valid measure of coping self-efficacy.

Gender in relation to relapse crisis situations, coping, and outcome among treated alcoholics.

Relapse crisis situations resulting in successful coping (i.e., abstinence) and unsuccessful coping (i.e., relapse) were examined in 90 male and 35 female alcohol clients over the first 12 weeks following treatment discharge. More similarities than differences were observed between the genders in the relapse crisis situations encountered, the number and type of coping strategies used, and the drinking outcome results. A similar proportion of males and females successfully abstained in the first 12 weeks posttreatment; a combination of cognitive and behavioral coping was most frequently used by both genders, and negative emotional states constituted the most commonly reported relapse crisis situation. Survival of a relapse crisis was strongly associated with the number of coping strategies used by both men and women. There was a nonsignificant trend for females to relapse more frequently in negative affect situations (i.e., negative emotions, conflict with others) and males in the presence of other drinkers. Further studies employing larger sample sizes are needed to examine gender differences in the process of relapse.

Retention in substance abuse treatment. Role of psychiatric symptom severity.

The authors investigated the association between psychiatric symptom severity and subsequent treatment retention among substance abusers. The Symptom Check List-90-R was administered, after admission to an addiction treatment facility, to 308 male and 106 female clients with moderate-to-severe substance abuse problems. Mean scores on nine symptom and three summary scales were computed. Controlling for other sociodemographic and treatment variables, somatization was significantly associated with dropout from specialized outpatient and inpatient treatment programs. This study, however, suggests that psychopathologic symptom severity at admission has only limited utility in predicting subsequent treatment retention among substance abusers with overall moderate levels of psychological distress.

Development and validation of the drug-taking confidence questionnaire: a measure of coping self-efficacy.

The Drug-Taking Confidence Questionnaire (DTCQ; Annis & Martin, 1985) is a 50-item self-report questionnaire developed to assess situation-specific coping self-efficacy for use of a particular substance of abuse (e.g., cocaine, heroin, alcohol, cannabis, etc.). Results from exploratory and confirmatory factor analyses of the DTCQ on 713 clients seeking treatment at an addiction treatment facility provided strong evidence for the situation-specificity of efficacy beliefs. An 8-factor first-order model, based on the eight high-risk categories for relapse identified by G.A. Marlatt (Marlatt & Gordon, 1980) and a 3-factor second-order model (i.e., negative situations, positive situations, and temptation situations) provided the best fit to the data. All eight subscales of the DTCQ were shown to have good reliability (alphas .79 to .95). Extensive convergent and discriminant validity analyses for the DTCQ and its subscales in relation to ADS, DAST, OES, DRIE, SCQ, SCL-90R, BDI, HS, and SOCRATES substantiate that the DTCQ is a promising tool for further research and clinical application.

Measurement of antecedents to drug and alcohol use: psychometric properties of the Inventory of Drug-Taking Situations (IDTS).

The development, factor structure, and validity of the Inventory of Drug-Taking Situations (IDTS) is described. This 50-item self-report questionnaire, which is an extension of the Inventory of Drinking Situations (Annis, 1982. Inventory of drinking situations; Annis, Graham & Davis, 1987, Inventory of drinking situations (IDS): User's guide), is designed to assess the situational antecedents to use of a wide range of drugs of abuse. The IDTS consists of 8 subscales that measure a client's substance use in the 8 situations identified in the work of Marlatt (1978, Alcoholism: New directions in behavioral research and treatment): Unpleasant Emotions, Physical Discomfort, Pleasant Emotions, Testing Personal Control, Urges and Temptations to Use, Conflict with Others, Social Pressure to Use, and Pleasant Times with Others. Reliability, factor structure and validity of the IDTS were assessed on 699 clients admitted to the Addiction Research Foundation's treatment facility in Toronto. The IDTS was shown to have reliable subscales. The IDTS total score correlated with self-ratings of the severity of the clients' substance use problem, and with retrospective reports of frequency of use (drugs) and quantity of use (alcohol), years of usage, and severity of dependence. Confirmatory factor analysis was used to test the fit of the data to Marlatt's model of substance use situations, as well as to several alternative models. The goodness-of-fit indicators suggested that the best fit for the data was an 8-factor model corresponding to the 8 subscales based on the Marlatt categories. Evidence was presented that the 8 subscales can be further grouped into 3 second-order factors: (1) negative situations, (2) positive situations, and (3) temptation situations. The negative situation subscales of Unpleasant Emotions, Conflict with Others and Physical Discomfort were found to be correlated with the SCL-90R Depression scale. Interpersonal Sensitivity scale and Somatization scale respectively. The positive social situation subscales of Pleasant Times with Others and Social Pressure to Use were found to be negatively correlated with percentage of time using alone, and positively correlated with pressure from friends and family to use. On the States of Change Readiness and Treatment Eagerness Scales (SOCRATES), clients at the precontemplation stage of change had relatively flat, undifferentiated IDTS profiles (i.e. little scatter of subscale scores), whereas clients in the determination stage had the most differentiation in their IDTS subscale scores. Excellent comparability was found for alcohol clients between the IDS and the IDTS. Evidence was also presented for adequate comparability between the computer and paper and pencil administrative formats of the IDTS.

Welfare reform and access to family-supportive benefits in the workplace.

Welfare reform has focused on the deficits of poor mothers, while ignoring inadequacies in the jobs and workplaces they will enter. This study of 2,375 pregnant women in the labor force examines the impact of job and workplace characteristics on access to workplace benefits that are important to families, while controlling statistically for women's education, marital status, and ethnicity.

Fetal foot length as a predictor of gestational age.

Ultrasonographic measurement of fetal foot length is useful in the assessment of gestational age. Two hundred twenty-three postpartum and 224 ultrasonographic measurements were performed between 11 and 43 weeks' gestation; 207 postpartum and 160 ultrasonographic measurements met our requirements of secure dates and no physical anomaly or maternal disease. Mean foot length at each week of gestation compared favorably with Streeter's data, based on pathologic specimens, described in 1920. Comparison of curvilinear regression of foot length versus gestational age demonstrated a strong correlation with an R2 value of 0.981; 95% confidence intervals at each week compared favorably with both biparietal diameter and femur length data. Fetal foot length is a reliable parameter for use in the assessment of gestational age and is particularly useful when other parameters do not accurately predict gestational age, for example, hydrocephalus, anencephaly, short limb dysplasia.

Randomized comparison of cefamandole, cefazolin, and cefuroxime prophylaxis in open-heart surgery.

A total of 337 patients undergoing coronary artery bypass grafting or cardiac valve replacement were randomly assigned to receive cefazolin (1 g every 8 h [q8h]), cefamandole (2 g q6h), or cefuroxime (1.5 g q12h) as an intravenous antibiotic prophylaxis. All drugs were administered within 60 min before the initial incision and were continued for 48 h postoperatively. No adverse effects related to the study drugs were observed. The percentage of patients with postoperative infection was 9% for the cefazolin group, 6% for the cefamandole group, and 5% for the cefuroxime group or 6.5% overall. There were more infection sites in patients treated with cefazolin than in those treated with cefuroxime (P = 0.05) or cefamandole (P = 0.06). Fewer wound infections occurred with cefuroxime (P less than 0.01) and cefamandole (P = 0.06) than with cefazolin. Analyses of the prophylactic regimens used in this study showed cefazolin and cefuroxime to be less costly than cefamandole.

Management of a child with acute thyroxine ingestion.

We report a case of thyroxine overdose in a child. Despite extremely high thyroxine (T4RIA) levels on admission, the patient's only symptoms were mild hypertension and tachycardia. Both symptoms responded to propranolol, with a drop in pulse rate and a decrease in blood pressure to normal levels. After four days of cardiac monitoring, the patient was released and received propranolol for five additional days as an outpatient.

Herpes zoster. The treatment and prevention of neuralgia with adenosine monophosphate.

Thirty-two adults were enrolled in a randomized, placebo-controlled double-blind trial of intramuscular injections of gel-sustained adenosine monophosphate (AMP) given three times a week for up to four weeks for acute herpes zoster. Adenosine monophosphate moderately reduced the pain soon after the start of treatment, decreased desquamation time, and promoted faster healing of the skin than placebo treatment. Adenosine monophosphate treatment reduced virus shedding and cleared the virus faster than in placebo-treated subjects. At the end of the initial four-week treatment period, 88% of AMP-treated patients were pain free, as opposed to only 43% in the placebo group. After four weeks, all patients who had not recovered from pain started receiving AMP treatment without breaking the code. All these patients recovered from pain within three weeks after initiation of treatment. No recurrence of pain or lesions was experienced from three to 18 months after the end of treatment. Adenosine monophosphate, a natural cellular metabolite, showed no side effects or toxicity during and after the treatment.

Enhanced theophylline clearance secondary to phenytoin therapy.

This report describes two cases in which theophylline clearance accelerated markedly with concomitant phenytoin administration. Maximum calculated theophylline clearance ranged from 2 1/2 to 3 1/2 times baseline. Onset of the interaction began within five days of beginning concurrent therapy. With combined use, clinicians should be aware, when phenytoin is added, of the potential for reexacerbation of pulmonary symptomatology due to lowered serum theophylline concentrations.

Immune function in blood donors following short-term lymphocytapheresis.

Lymphocyte losses occur during repeat plateletpheresis and/or leukapheresis procedures and are potentially harmful to normal host immune function. This concern prompted us to study the effect of repeat lymphocytapheresis (lymphapheresis) on the immune system of healthy blood donors. Following a total of six lymphapheresis procedures over a 12-day period with removal of a mean of 41.6 X 10(9) lymphocytes, there were no significant changes in donor (n = 5) absolute lymphocyte counts, quantitative immunoglobulin levels or immune response capability as assessed by the following in vitro assays: percent of E, EA, and EAC rosette-forming cells, the percent of surface membrane immunoglobulin bearing cells, and the blastogenic responses to stimulation with phytohemagglutinin, pokeweed mitogen and concanavalin A. The procedures were well-tolerated without complications. During a follow-up period of 18 months, significant increases in total white cell counts (but not absolute lymphocyte counts), and in quantitative immunoglobulin levels (IgG, IgM, and IgA) were observed. The median increases in immunoglobulin levels ranged from 27.5% for IgG to 44% for IgA. We conclude that lymphapheresis as described is relatively safe and our results are reassuring in relation to lymphocyte losses that may occur during repeat cytapheresis procedures of normal blood donors.

Surface receptors and immune activity of purified human circulating mononuclear cells. IV. The demonstration of seven subclasses of T cells in the circulation of the normal individual: the cytotoxic activities of these cells.

T lymphocytes were isolated from monocyte-depleted mononuclear cells of normal individuals by rosetting them with sheep erythrocytes. These purified T cells were preferentially depleted of cells with receptors for FcG (TG cells), FcM (TM cells), or C'3 (TC cells) by rosette formation with EA(G), EA(M), and EAC, respectively, before or after incubation for 24 hr in medium 199 fortified with fetal calf serum (20%). The unfractionated lymphocytes and the purified and the depleted T cells were analyzed for receptors to FcG, FcM, and C'3 and for cytotoxic activity in the natural killer (NK), antibody dependent cell-mediated cytotoxicity (ADCC), and mitogen-induced cell-mediated cytotoxicity (MICC) assays. The TG and TC cells were detected among the freshly isolated T cells, whereas the TM cells were detected only following 24 hr of incubation. Removal of TC cells from the 24-hr-cultured T cells resulted in removal of all the TC cells and in the concomitant removal of the majority of TM cells. Similarly, removal of TM cells from the 24-hr-cultured T cells resulted in the elimination of all TM cells as well as the majority of TC cells. These results demonstrate the in vitro generation of T cells with receptors for both FcM and C'3 (TM+C cells). Ten percent of the freshly isolated TG cells possessed detectable receptors for C'3 and/or FcM. These cells constitute the TG+C and TG+M lymphocytes. Support for consideration of these receptor-bearing cells as unique and stable cells is provided by the finding that TM and TC cells maintained in culture for up to 72 hr do not generate other receptors but retain the single receptor which characterizes each of these cells. Only a small percentage of cultured TG cells generate receptors for C'3 and FcM. It may therefore be concluded that the TG, TM, and TC cells are stable unireceptor-bearing cells. The TG, TM, TC, TG+C, TG+M, and TM+C lymphocytes account for approximately 50% of the circulating lymphocytes. Whether the remaining cells, the T null or TN cells, constitute the precursors for any or all of the receptor-bearing T cells remains to be determined. Unfractionated freshly isolated T cells were highly cytotoxic in the NK and PWM-mediated MICC assays but were relatively inactive in the ADCC, naturally occurring cell-mediated cytotoxicity (NOCC), and PHA- and Con-A-mediated MICC assays.(ABSTRACT TRUNCATED AT 400 WORDS)

Activity of AMP against experimental herpes simplex virus type 1 infections in mice.

Administration of AMP soon after inoculation of mice with herpes simplex virus type 1 inhibited development of virus-induced lesions and appeared to prevent establishment of virus latency. These effects were dependent on both the AMP dose and the time of AMP administration. Regression of herpes simplex virus type 1-induced lesions was also accelerated significantly by AMP treatment in a time- and dose-dependent manner.