Helping them cope.

1. Self-help groups for individuals with sarcoidosis (a noncontagious multisystem disorder characterized by granulomas in many organs) are rare despite the physical and emotional problems associated with this disease. 2. The stimulus for the development of the group arose when staff in a pulmonary clinic identified that sarcoidosis patients were helping each other cope with problems and concerns related to their disease and feelings of isolation. 3. Nurses play a significant role in creating vehicles of help and service to facilitate and support patients experiencing fear and anxiety about their disease. Nurses must recognize the role self-help groups play in assisting individuals to maintain their quality of life as they adapt to the psychosocial, physiological, and medical aspects of their illness.

Replacement therapy for alpha 1-antitrypsin deficiency associated with emphysema.

In patients with alpha 1-antitrypsin deficiency, the development of emphysema is believed to be caused by the unchecked action of proteases on lung tissue. We evaluated the feasibility, safety, and biochemical efficacy of intermittent infusions of alpha 1-antitrypsin in the treatment of patients with alpha 1-antitrypsin deficiency. Twenty-one patients were given 60 mg of active plasma-derived alpha 1-antitrypsin per kilogram of body weight, once a week for up to six months. After a steady state had been reached, the group had trough serum levels of alpha 1-antitrypsin of 126 +/- 1 mg per deciliter as compared with 30 +/- 1 mg per deciliter before treatment, and serum anti-neutrophil elastase capacities of 13.3 +/- 0.1 microM as compared with 5.4 +/- 0.1 microM. The alpha 1-antitrypsin level in the epithelial-lining fluid of the lungs was 0.46 +/- 0.16 microM before treatment, and the anti-neutrophil elastase capacity was 0.81 +/- 0.13 microM. Six days after infusion, alpha 1-antitrypsin levels (1.89 +/- 0.17 microM) and anti-neutrophil elastase capacities (1.65 +/- 0.13 microM) in the lining fluid were significantly increased (P less than 0.0001). Because of the chronicity of the disorder and the lack of sensitive measures of lung destruction, the clinical efficacy of this therapy could not be studied rigorously. No changes in lung function were observed in our patients over six months of treatment. The only important adverse reactions to the 507 infusions were four episodes of self-limited fever. This study demonstrates that infusions of alpha 1-antitrypsin derived from plasma are safe and can reverse the biochemical abnormalities in serum and lung fluid that characterize this disorder. Together with lifetime avoidance of cigarette smoking, replacement therapy with alpha 1-antitrypsin may be a logical approach to long-term medical treatment.

Potential organ- or tumor-imaging agents. 22. Acyl-labeled cholesterol esters.

A series of cholesteryl phenylalkanoic esters was synthesized in which the acyl moiety served as the carrier for radioiodine. Tissue distribution studies in rats revealed that several of these radioiodinated esters selectively accumulated in steroid-secreting tissues, such as the adrenal cortex and ovary. Furthermore, this selective uptake was shown to correlate with the stability of these esters to in vivo hydrolysis. An unexpected finding was the unusually high propensity of some of these esters to localize in the ovary and thus afford a possible approach to ovarian imaging agents.