Unresectable primary and recurrent head and neck tumors: effect of hyperthermia and carboplatin--preliminary experience.

PURPOSE: To perform a single-arm study to determine the effectiveness of and potential toxic reactions to local hyperthermia and systemic carboplatin (cis-diammine-1,1-cyclobutane dicarboxylate platinum II) for the treatment of advanced or recurrent squamous cell carcinomas of the head and neck. MATERIALS AND METHODS: Eight patients with squamous cell carcinoma of the head and neck and stage IV disease (N2 or N3 neck adenopathy) or recurrent local-regional disease and who were previously and definitively treated were included in the study. Thermochemotherapy was administered every 4 weeks. Recorded end points were tumor response, duration of response, incidence of distant metastases, survival, cause of death, and toxic reactions. RESULTS: One patient had a complete response to therapy, and two had a partial response. Five patients had no response or developed progressive disease during therapy. Six patients died after 4-13 months of progressive disease. Two long-term survivors received radiation therapy; one also underwent surgical resection for residual neck disease. Each thermochemotherapeutic session was well tolerated, with minimal discomfort. Toxic reactions included hypotension, vomiting, hyponatremia, anemia, thrombocytopenia, and infection at the site of administration. There were no life-threatening toxic reactions. CONCLUSION: The combined use of hyperthermia and carboplatin shows potential in the management of unresectable head and neck tumors and is safe and well tolerated. Further studies on thermochemotherapy are warranted to assess its potential.

Improve quality in nursing homes or institute community placement? Implementation of OBRA for individuals with mental retardation.

A matched sample longitudinal design was used to compare the outcomes for individuals with mental retardation who were either retained in nursing homes or transferred to community based living arrangements. Persons who moved from nursing homes to community residences experienced increased performance in adaptive behavior skills, whereas persons who remained in nursing homes regressed. Individual habilitation plans became nearly universal in both environments, but those plans prepared in the community were more focused on vocational type goals. Hours of service also increased in both environments, with the greatest increases being observed in habilitation training. Nursing services dropped to near-zero levels in community-based programs.

Adolescent developmental change in topography of EEG amplitude.

EEGs were recorded from 32 channels in 30 normal males, ages 16-22. Delta activity decreased throughout this age range. This decrease was greatest in the left frontal and temporal regions; no occipital lead showed this pattern. Relative EEG amplitude analysis, based on normalized maps, revealed decreases with age across alpha, delta, and theta bands with beta staying the same or increasing. These changes were greatest in the left temporal and left frontal regions. Taken together, these findings suggest that these cortical areas are maturing in the second decade of life. Both delta and theta showed significantly greater decreases with age in the left parietal region than in the right.

Focal left temporal slow EEG activity is related to a verbal recent memory deficit in a non-demented elderly population.

Neuropsychological measures of memory and cognition and topographical quantitative EEG were obtained on 35 healthy, non-demented, right-handed, elderly subjects aged 60-81. All were free of medications which impair cognition. They were divided into a left temporal slow abnormality group (n = 9) and a control group (n = 26) on the basis of topographically normalized measures of both delta and theta activity for the left temporal lead T3. The group with left temporal slow activity was significantly deficient on measures of memory savings and memory losses derived from the Logical Memory (Story Recall) Test in the Wechsler Memory Scale--Revised. There were no significant differences between these two groups on the non-memory cognitive tasks. This predominant verbal recent memory deficit profile is reasonably similar to the neuropsychological deficit profile of very mildly demented Alzheimer patients. Because left temporal slow EEG activity is also the predominant EEG abnormality in mild Alzheimer patients, a prospective study should be done to determine if this abnormality in non-demented elderly subjects is most often a preclinical sign of Alzheimer's disease.

Abnormal EEG slow activity in left temporal areas in senile dementia of the Alzheimer type.

Resting 32-channel topographical measures of EEG slow activity were compared in 12 elderly controls and 12 patients with senile dementia of the Alzheimer type. The patients had higher amplitude delta and theta than controls, especially in the left temporal regions. This greater amount of low frequency EEG activity in the left temporal area is consistent with recent EEG, neuropsychological assessment, and positron emission tomography findings in SDAT patients. Five patients with mild-to-moderate dementia (as determined by the Folstein Mini-Mental State scale) primarily exhibited focal, abnormal slow activity in the left temporal regions. Seven patients with severe dementia exhibited increased slow activity across the head, which was still most abnormal in the left temporal regions.

EEG alpha photic driving abnormalities in chronic schizophrenia.

Periodic photic stimuli across the entire electroencephalographic (EEG) frequency range were used in an attempt to assess EEG functional differences between chronic schizophrenic patients and control subjects. The EEG responses to these photic stimuli were significantly attenuated in the schizophrenic patients, specifically at the frequencies within the EEG alpha range. The schizophrenic patients also showed an alpha range attenuation in the "no stimulus" EEG alpha measure, such that there was a significant correlation across subjects between the "stimulus" and "no stimulus" EEG alpha range abnormalities. These abnormalities are discussed with reference to possible dysfunctional thalamic mechanisms involved in the pacing of EEG alpha activity and the gating of information through the cerebral cortex.

Some evidence in support of a relationship between human auditory signal-detection performance and the phase of the alpha cycle.

This study concerned the hypothesis presented by Lindsley in 1961 that human sensorimotor performance should vary with the phase of the alpha cycle. Although there have been a number of studies which have supported this hypothesis, there has been no work from a modality other than the visual modality. Since eye tremor is correlated in phase and frequency with the alpha rhythm, these visual results might be explained by the peripheral eye tremor and not necessarily by the central alpha rhythm. The present study measured human auditory signal-detection performance at four different phases of the temporally (T5-linked mastoids) measured alpha rhythm. These four different phases were defined on an a priori basis by a computer algorithm. Detection performance was significantly better at the negative peak of this alpha cycle than at the positive peak, but there was no significant difference between the positively and negatively going zero cross performances. These results are consistent with the Lindsley hypothesis.

Comparison of diflunisal and piroxicam in the management of patients with rheumatoid arthritis.

The efficacy and tolerability of diflunisal (500 mg orally, twice daily) and piroxicam (20 mg orally, once daily) were compared in a 12-week open-label study in 44 patients with active rheumatoid arthritis. Both medications were equally effective and generally well tolerated. No significant differences were found between drug groups. Both groups showed statistically significant improvement in the overall number of swollen and tender joints, painful joint count, and the patients' assessment of pain and disease severity. Two (9%) of 23 patients in the diflunisal group and one (5%) of 21 patients in the piroxicam group reported adverse effects. Only one patient withdrew from the study because of side effects (lightheadedness during use of diflunisal). It is concluded that both diflunisal and piroxicam are highly effective and generally well tolerated in the management of rheumatoid arthritis.

Primary lymphoma of bone presenting as monoarthritis.

We report an unusual case of primary non-Hodgkin's lymphoma or reticulum cell sarcoma of bone presenting as monoarthritis in a middle-aged woman without previous rheumatic disease. She underwent rheumatologic evaluation of plasma and synovial fluid, synovial cytology, arthroscopy, synovial and bone biopsies. Our evaluation may be the most thorough rheumatologic one yet reported.

Molecular dynamics and conformation in the gel and liquid-crystalline phases of phosphatidylethanolamine bilayers.

Solid-state deuterium and carbon-13 nuclear magnetic resonance (NMR) spectra have been used to study the molecular dynamics and conformation of dipalmitoylphosphatidylethanolamine (DPPE) in both the gel (L beta) and liquid-crystalline (L alpha) phases. For this purpose DPPE was labeled with 13C in the carbonyl group of the sn-2 chain and with 2H at three different positions--4, 8, and 12--of the sn-2 chain, at the 2 position of the glycerol backbone, and at the 1 position of the ethanolamine head group. The 13C carbonyl and 2H chain spectra indicate that in the gel phase the DPPE molecules are diffusing about their long axes at rates of 10(5)-10(6) s-1 and the acyl chains are in an approximately all-trans conformation. The glycerol backbone spectra suggest that the backbone is in a gauche conformation in the gel state, rather than a trans conformation such as found in single crystals. The head group spectra in the gel phase are broad, featureless lines of about 20-kHz width. At the L beta leads to L alpha phase transition several changes take place. As is well-known, the chains disorder, and fast long-axis rotational diffusion begins, which results in the sharp, axially symmetric L alpha phase 2H spectra, which are a factor of 2 narrower than those observed in the L beta phase. The head group spectra also sharpen substantially at the transition, although their total width remains approximately constant. The invariance of the spectral width suggests that the average head group conformation is similar in both phases. However, the sharper spectra seen in the L alpha phase indicate that the rates of the head group motions in this phase are at least 3 orders of magnitude faster than those in the L beta phase. Thirdly, the 2H spectra of the glycerol backbone labeled DPPE narrow by a factor of about 4, and we believe this is due to a conformational change in this region of the molecule. Consistent with this interpretation is the fact that the powder pattern exhibited by the sn-2 13C = O in the L beta phase collapses to an isotropic-like line at the phase transition.

"Labrador lung": an unusual mixed dust pneumoconiosis.

Forty-eight workers involved for various periods from 1962 in mining and milling iron-containing rock in the Carol Lake area of western Labrador were found in late 1974 and early 1975 to have pneumoconiosis. Their annual chest roentgenograms demonstrated irregular nodular densities, and several revealed mild hilar lymphadenopathy or pleural thickening. All 48 workers were asymptomatic and had normal pulmonary function; their average age was 38 years. At work they had been exposed to high levels of dust containing iron, silica and anthophyllite, a type of asbestos. Lung biopsy specimens from 13 of them showed widespread focal fibrosis, large amounts of hemosiderin and silica and many ferruginous bodies; one ferruginous body was identified as having a core of anthophyllite. A granulomatous reaction was seen in two biopsy specimens and typical silicotic nodules were found in two others. The relatively brief exposure, especially in ones case (11 months), and the short latent interval before the development of the pneumoconiosis are reasons for concern for the health of iron ore workers.

Synthesis of isotopically labeled saturated fatty acids.

An approach to the synthesis of isotopically labeled saturated fatty acids is outlined which is based on the copper-catalyzed coupling of an omega-bromo acid with an isotopically labeled Grignard reagent. The method provides high yields of pure products and offers considerable flexibility in the type of isotopically enriched compound that can be prepared.-DasGupta, S. K., D. M. Rice, and R. G. Griffin. Synthesis of isotopically labeled saturated fatty acids.

Protein-lipid interactions. A nuclear magnetic resonance study of sarcoplasmic reticulum Ca2,Mg2+-ATPase, lipophilin, and proteolipid apoprotein-lecithin systems and a comparison with the effects of cholesterol.

Deuterium Fourier transform nuclear magnetic resonance (NMR) spectra at 34 MHz (corresponding to a magnetic field strength of 5.2 T) have been obtained of a variety of protein-lipid systems containing specifically deuterated phospholipids. The following systems were investigated as a function of temperature: sarcoplasmic reticulum ATPase (ATP phosphohydrolase, EC 3.6.1.3) complexed with 1-myristoyl-2-(14,14,14-trideuteriomyristoyl)-sn-glycero-3-phosphocholine (DMPC-d3) or 1,2-bis(16,16,16-trideuteriopalmitoyl)-sn-glycero-3-phosphocholine (DPPC-k6); human brain lipophilin complexed with DPPC-d6 or 1,2-bis(6,6-dideuteriopalmitoyl)-sn-glycero-3-phosphocholine (DPPC-6,6-d4); beef brain myelin proteolipid apoprotein (PLA) reconstituted with DMPC labeled as CD2 (or CD3) at one or more of positions 3, 4, 6, 8, 10, 12, or 14 of the sn-2 chain. For purposes of comparison, spectra were also obtained for bilayers containing cholesterol (CHOL). The results show that proteins either disorder or have little effect on hydrocarbon chain order in membranes above the gel to liquid-crystal phase transition temperature (Tc) of the pure lipids. Cholesterol, however, causes a very large ordering of the hydrocarbon chains above Tc, but both cholesterol and protein prevent chain crystallization (by effectively disordering chain packing) immediately below Tc. No evidence for any ordered "boundary lipid" in association with protein was found above Tc, perhaps due to the rough nature of protein surfaces. Above Tc, exchange between free bilayer and protein associated lipid is fast on the time scale of the deuterium NMR experiment (greater than or similar to 10(3) s-1). We have also obtained proton-decoupled phosphorus-31 nuclear magnetic resonance spectra at 60.7 MHz (corresponding to a magnetic field strength of 3.5 T) of DMPC, DMPC-AT-Pase, and DMPC-CHOL complexes. The results indicate that ATPase and CHOL CAUSE SMALL DECREASES IN 31P chemical shielding anisotropies but that in addition ATPase causes a four- to fivefold increase in 31P spin-lattice and Carr-Purcell spin-spin relaxation rates, suggesting the possibility of polar group protein-lipid interaction leading to increased correlation times in the region of the lipid phosphate head group.

An instrument for the recording of student health complaints.

This study described the development and uses of an instrument for the systematic collection of student health complaints in school. A booklet was prepared listing all student's names for one rural elementary school. A code to indicate date, class period, complaint, and outcome was utilized for collecting data. After a 2.5 month trial period, data were analyzed. The findings revealed 418 visits to the school health room -- range of visits by classroom was 3 to 71 -- most visits were for stomach ache or physical injury -- one classroom accounted for 16% of all visits -- fourth and sixth grades had a significantly larger number of visits than grades three, five, and seven.