The expression of cytokine activity by fracture callus.

Cytokines, a group of proteins known to regulate hemopoietic and immune functions, are also involved in inflammation, angiogenesis, and bone and cartilage metabolism. Since all of these processes occur following bone injury, or are known to contribute to wound repair mechanisms, this investigation sought to test the hypothesis that cytokines are involved in fracture healing. Two sets of 60 male Sprague-Dawley rats underwent the production of standard closed femoral fractures. The animals were then euthanized in groups of 15 on days 3, 7, 14, and 21 postfracture. A separate control group was also used for the harvesting of intact unfractured bone. At the time of euthanasia, calluses or bone specimens were explanted to organ culture and treated with either media alone or media containing the inducing agents lipopolysaccharide or concanavalin A. A titration of conditioned medium from these cultures was then added to factor-dependent clonal cell lines that are known to be specifically responsive to interleukin-1, interleukin-6, granulocyte-macrophage colony stimulating factor or macrophage-colony stimulating factor. To confirm the identities of each of these cytokines, neutralizing antibody studies were performed. The results showed that interleukin-1 is expressed at very low constitutive levels throughout the period of fracture healing but can be induced to high activities in the early inflammatory phase (day 3). Granulocyte-macrophage colony stimulating factor showed no constitutive activity but could also be induced to high activities with lipopolysaccharide. The ability of these two cytokines to be induced declined progressively as fracture healing proceeded. Interleukin-6 showed high constitutive activity early in the healing process (day 3), and treatment with inducing agent did not increase the activity of this cytokine at this timepoint. Lipopolysaccharide did increase interleukin-6 activity in day 7 and 14 fracture calluses. Although macrophage-colony stimulating factor is thought to be involved in a variety of metabolic bone conditions, it could not be detected or induced from any of the callus samples. Moreover, none of the samples of unfractured bone showed constitutive or inducible activities for any of these cytokines. A separate experiment in which calluses and samples of unfractured bone from similar cultures were examined histologically and tested for DNA or protein synthesis at two timepoints in the culture period (days 1 and 4) showed that tissue viability was maintained. Thus the inability to detect macrophage colony-stimulating factor in fracture callus or any cytokine activity in unfractured bones was not due to cell death.(ABSTRACT TRUNCATED AT 400 WORDS)

Psychosocial aspects of neoplastic disease. III. Group support for the oncology nurse.

The attitudes of oncology nurses to job-related concepts were assessed by the Semantic Differential List prior to beginning and following six months of weekly 1.5 hour psychodynamically oriented support group sessions. These attitudes were compared to oncology nurses not in the group experience during the same time span. The oncology nurses who had completed the group experience had more negative attitude shifts to the job-pertinent concepts and also showed a greater amount of attitude change in the negative direction than those oncology nurses not in the group. These findings point to the importance of denial in cancer center personnel and indicate that an educational model of group therapy may be more appropriate for this group of health professionals.

Psychosocial aspects of neoplastic disease: II. Affective and cognitive effects of chemotherapy in cancer patients.

A battery of cognitive and affective tests administered to 50 consecutively admitted medical oncology patients revealed cognitive impairment to be a common occurrence in the absence of affective disorders or other psychopathology. Chemotherapy was the major variable associated with cognitive impairment in these patients. These findings suggest that the consultant psychiatrist should be aware of chemotherapy as a possible source of behavioral change and emotional distress in cancer patients.

Age at onset of bipolar affective illness.

The age at onset of bipolar affective illness was determined for 100 males and 100 females who met the newly proposed DSM-III criteria for mania. Three different indices of onset were employed: first hospitalization, first treatment, and first apparent symptoms. A table was constructed indicating the cumulative percentage of those who became ill by the time they passed through each age quinquennium. One third were hospitalized before their 25th birthday, and at least 20% had already shown evidence of illness as adolescents. The early 20s was the peak period of onset. No manic episodes were confirmed prior to age 13, and onset after age 60 was rare. Sex, ethnicity, and socioeconomic status did not significantly affect age at onset. Affective illness should be given serious consideration in the differential diagnosis of mental disorders in young people.

Mental disorders in cancer patients: a study of 100 psychiatric referrals.

Records of 100 consecutive hospitalized cancer patients referred for psychiatric consultation were reviewed. These patients constituted only 5% of those seen by the Psychiatry Consultation Service during the study period. Fifty-six percent of the referred patients were diagnosed as depressed and 40% as having organic brain disease. Twenty-six of the 100 patients were misdiagnosed by the referring physician as depressed but were classified by the staff psychiatrist as suffering from organic brain syndrome. When referral was studied by primary site of cancer, only patients with breast cancer were referred at a significantly higher than expected rate (p less than .001). The importance of the mental status examination as a routine procedure in all cancer patients is stressed so that an organic brain syndrome will not be missed. Suggestions for patient management are given.