A public health approach to emergency medicine: preparing for the twenty-first century.

This paper focuses on the implications of an inadequate public health/preventive health care system for emergency medicine (EM), the role that EM providers can play in remedying critical health problems, and the benefits gained from a public health approach to EM. A broad definition of public health is adopted, suggesting shared goals of public health and EM. Critical problems posed for EM include alcohol, tobacco, and other drug abuse; injury; violence; sexually transmitted diseases and human immunodeficiency virus (HIV) infection occupational and environmental exposures; and the unmet health needs of minorities and women. A blueprint for future merging of public health issues with EM is presented that includes the application of public health principles to 1) clinical practice; 2) public education, community involvement, and public policy advocacy; 3) development of medical school and residency public health/prevention curricula and teaching methods; and 4) research opportunities and surveillance. Finally, recommendations are proposed that require restructuring the present health care system to provide resources, incentives, and organizational changes that promote an integration of public health and preventive services in the practice of EM.

Distinctive protein pattern in two-dimensional electrophoretograms of cancerous prostatic tissues.

In this report, we describe methods used to analyze the protein composition of sectioned frozen prostatic tissues by two-dimensional gel electrophoresis. Our results show a high degree of homology in two-dimensional electrophoretograms of proteins extracted from frozen sections of malignant prostate glands. Such homology was not apparent in protein patterns of benign hypertrophic prostatic tissue sections. Typically, 600 discrete proteins were resolved on two-dimensional electrophoretograms and 9 proteins were present in all patterns of prostate adenocarcinomatous tissues. These nine proteins were not observed in any of the protein electrophoretograms developed from nonmalignant prostate tissue. Three proteins were found common to nonmalignant prostate glands but were not present in prostatic adenocarcinoma.

Two-dimensional electrophoretic analysis of human prostatic fluid proteins.

The heterogeneous mixture of proteins present in expressed prostatic fluid from forty-nine men over 25 years old was analyzed on two-dimensional electrophoretic gels stained with silver. Samples were collected from men diagnosed with chronic prostatitis, urinary tract infection, benign prostatic hypertrophy (BPH), and prostatic carcinoma. Reference patterns were developed for all proteins observed in electrophoretograms. Over 1000 distinct proteins are contained in the comprehensive proteins pattern of prostatic fluid; however, only 18 proteins were common to all samples. No proteins unique to fluids from men with BPH or prostatic cancer were observed. Some proteins in the common proteins reference pattern of BPH patients were not seen in samples from men with prostatic cancer. Our preliminary results indicate that a series of proteins tentatively identified as variants of prostatic acid phosphatase appeared elevated in all BPH fluids but was absent or below limits of detection in samples from men with prostatic carcinoma. Our studies indicate that proteins secreted in prostatic fluid reflect physiological changes in the prostate, and certain changes may be useful indicators of malignant transformation.

Mechanisms for the renal secretion of cisplatin.

Cisplatin (cisDDP) inhibits the active uptake of tetraethylammonium and p-aminohippurate by mouse kidney slices. The shapes of the dose-response curves for inhibition of the organic cation and organic anion transport are different, and the inhibition is competitive in each case. Thus, the inhibition by cisDDP may be due to interaction of cisDDP or its aquated products with the specific transport sites rather than to nonspecific metabolic poisoning of the slices by cisDDP. In mice, cimetidine inhibits the renal secretion of tetraethylammonium but fails to inhibit the secretion of p-amminohippurate. The renal clearance of total platinum in mice treated with cisDDP did not exceed that of inulin; however, the clearance of platinum was reduced by cimetidine. These results suggest that the organic cation secretory system plays a role in the renal handling of cisDDP or its products.

Renal secretion of purine nucleosides and their analogs in mice.

Previous results have indicated that 2'-deoxyadenosine (dAdo) and 2'-deoxytubercidin (dTub) are secreted by the mouse kidney. Secretion of dTub appeared to occur via the organic cation carrier [J. F. Kuttesch, Jr. et al., Biochem. Pharmac. 31, 3387 (1982)]. In the current study, the structural specificity of the secretory system for d Tub was probed by evaluating the renal clearance of several sugar-modified dTub analogs. The following sugar-modified derivatives also underwent apparent secretion: 3'-deoxy, arabinosyl, and xylosyl. These results suggest a lack of structural specificity of the secretory system for dTub. Tubercidin was apparently reabsorbed, analogous to the observation in mice that adenosine clearance is less than that of inulin. In related experiments, a transport maximum for dAdo could not be demonstrated due to the marked pharmacologic activity of dAdo. Cimetidine was found to selectively inhibit the organic cation secretory system since it blocked the renal secretion of tetraethylammonium but not that of p-amminohippurate in mice. Correspondingly, cimetidine prevented the renal secretion dTub; however, cimetidine did not inhibit the renal secretion of dAdo nor the renal reabsorption of Ado. These results suggest that renal secretion of dTub occurs via the organic cation carrier. The mechanisms for the renal secretion of dAdo and for the renal reabsorption of Ado may be unique and independent of the organic cation system.