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After surgery, 100 adult cardiac surgical patients participated in a study to determine what information was important to them and how well prepared they were. Questionnaires were administered 5 to 10 days after surgery and 1 to 4 weeks after discharge. In general patients received information that they perceived to be important, and they believed that preparation was more than adequate. Patients indicated a need to know more information about medication side effects than they received, and they did not desire as much information about emotional changes or sexual activity as the literature suggested.

A study of homosexual men and women was undertaken to ascertain what factors contribute toward being open with health professionals about one's sexual orientation and how this openness affects quality of care. Six hundred twenty-two men and women responded to a questionnaire distributed in the Gay Community News. Almost half (49%) had explicitly shared with their primary health professional that they were homosexual, another 11% assumed their health provider knew, and only 7% would not share this information with their health provider under any circumstances. Those who had shared this information were more satisfied with their primary health professional and, if male, were more likely to have been checked for venereal disease. Health professionals' attitudes towards homosexuality were an important concern of respondents; 27% felt that a previous health professional had been prejudiced towards homosexual persons.

Because many patients with malignant pleural effusions could survive for months to years beyond its onset, definitive management must be safe and effective. Chemical pleurodesis with tetracycline has gained general acceptance as the therapy of choice, even though no large series confirming this viewpoint has appeared in the literature. We reviewed 108 procedures involving tube thoracostomy and tetracycline pleurodesis, and report a success rate of 94.4% without serious complications. Considering all patients, 49% were symptom-free at three months, and 13% were alive one year later. Several potentially important changes in technique have emerged since the initial description of this procedure. With adherence to meticulous technique, tetracycline pleurodesis provides rapid, effective, and safe palliation of malignant pleural effusions.

Maintenance of weight loss is an issue of interest to the dietetic practitioner. A series of 12 weight-loss classes was conducted using the behavioral approach. Mean weight loss of 11.1 lb. in this study compared favorably with weight losses in other studies reported in the literature. Continuous evaluation and updating of the program did not result in greater weight loss nor was it cost-effective. The participants who lost weight during the program tended to maintain weight loss over time. One-third of those participants attended additional weight-loss programs.

Yelin and others have shown social work factors to be more important than disease factors in predicting work disability among arthritis patients; however, the effects of family factors on work role functioning have not been considered in previous explanatory models. In this study, we use Yelin's model to explain work disability among 122 women with rheumatoid arthritis and to incorporate family factors into the model. Using logistic regression, we found, as with previous studies, that work autonomy, social factors, and disease factors are important predictors of work disability. In the logistic regression model, self-assessed health status seemed to be more important than work factors in predicting work status. Further, family factors significantly contributed to the explanatory model, in that having more home responsibilities was associated with lower risk of work disability.

Based on a behavioral analysis of compliance with breast self-examination (BSE), this study replicates a previously successful stimulus control intervention and tests the effectiveness of two types of reward for increasing compliance: external reward and self-reward. Patient volunteers (N = 153) were randomly assigned to experimental conditions and followed for 1 year, equally divided into experimental and postexperimental periods. Compliance was measured by the monthly return of BSE records, with self-reports used as a secondary measure. The results indicate that external reward was most effective; self-reward was used by only half the participants but was effective when used. In the postexperimental period, all rates of record return declined, especially in the external reward group. A cycle-by-cycle analysis indicates that the decline was gradual except for a sharp drop when the external reward was withdrawn. The results are discussed in terms of the acceptability of both interventions and contingencies.

Nutritional status before and after heart transplantation was analyzed from retrospective data on 65 patients (82% male, mean age, 43.1 years, and mean length of illness before transplantation, 57.3 months). Of all the patients 93% were on a 2 gm low sodium diet, and 55% were on a low saturated fat and low cholesterol diet before surgery. After surgery 100% of patients were on the same salt-, fat-, and cholesterol-restricted diet. Visceral protein stores (determined from albumin and total lymphocyte count) and somatic protein stores (determined from weight-for-height calculations, triceps skin fold, and arm muscle circumference) increased significantly from before surgery to 6 months after surgery. The number of patients with adequate visceral protein stores increased from 66.1% to 98.1%, and those with adequate somatic protein stores increased from 67.2% to 84.6%. Weight was analyzed over time with analysis of variance. Patients gained weight (preoperative mean = 72.8 kg and postoperative mean at 6 months = 80.2 kg), and ideal body weight increased from 102% to 114%. With paired t tests the following differed before and after surgery (p less than or equal to 0.05): cholesterol levels increased from 180 to 262 mg/dl, and triglyceride concentrations increased from 139 to 221 mg/dl. In conclusion, patient protein stores returned to normal after surgery, patients increased body weight to more than 110% of ideal, and cholesterol and triglyceride levels became elevated.

The evolution of our cardiac transplantation program necessitated learning new information and adding new personnel to keep pace with the needs of our patient population. As the program developed, the role of the clinical nurse specialist also changed. The clinical component remains important, but is now shared with additional nursing personnel. Therefore, the CNS is able to devote more time to new program development, which includes devising policies and procedures, nurse orientation, and research. The CNS assigns a high priority to these duties, which are vital in planning for excellence in patient care and contributing to the growing scientific knowledge about heart transplantation.

The incidence and sites of metachronous malignancies were retrospectively determined from the records of 763 patients seen at Yale University medical Center and affiliated hospitals with previously untreated, invasive carcinoma of the uterine cervix from 1953-1972. These patients were treated predominantly with radiation therapy; follow-up status was known for periods of 5-25 years or until time of death in over 96% of the patients. Forty-four patients had second malignancies noted at least 6 months after the initial cervical cancer was diagnosed. The expected incidence of second malignancies was determined from the Connecticut State Tumor Registry data controlling for year of diagnosis of the cervical cancer, patient age, sex, and time at risk (person-years exposure). To correct for any error in estimation of second malignancies introduced by the existence of a latency period for the development of a second cancer, the expected incidence of malignancies was also computed for 5-year time intervals following the cervical cancer. No significant increase in second malignancies was found (observed/expected-44/36) for the entire follow-up period nor for any individual 5-year interval. However, a statistically significant increase in lung cancer and vulva-vaginal cancer was noted and a significant decrease in breast cancer was observed. Cox regression analyses were performed to study the effect of total radium exposure and total external beam treatment, adjusting for other factors. No statistically significant increased risks were found.

Interest in a free breast self-examination (BSE) teaching program offered to a patient population (n = 1590) was assessed, and a follow-up survey of refusers undertaken to determine difference between participants and refusers. Fifty-one percent of the known, eligible women patients expressed interest in the program and 24% ultimately had the teaching. Participants differed from refusers most notably in terms of less previous experience with BSE, more family history of cancer, a longer relationship with their physicians, and different health beliefs. They state more confidence in the effectiveness of breast cancer detection and treatment, less fear and embarrassment, and more personal and physician responsibility for health outcomes, as measured by the Health Locus of Control Scales. Self-selection thus seems rationally based on the kind of program and the needs of the women. Such self-selection can be cost-effective in delivering health education to the people most in need of it and most likely to benefit from it.

Analysis of clones isolated from a cosmid DNA library indicates that the Serratia marcescens chromosome contains at least two genes, chiA and chiB, which encode distinct secreted forms of the enzyme chitinase. These genes have been characterized by inspection of chitinase activity and secreted proteins in Escherichia coli strains containing subclones of these cosmids. The two chitinase genes show no detectable homology to each other. DNA sequence analysis of one of the genes predicts an amino acid sequence with an N-terminal signal peptide typical of genes encoding secreted bacterial proteins. This gene was mutagenized by cloning a neomycin phosphotransferase gene within its coding region, and the insertion mutation was recombined into the parental S. marcescens strain. The resulting chiA mutant transconjugant showed reduced chitinase production, reduced inhibition of fungal spore germination and reduced biological control of a fungal plant pathogen.

A series of 12 behavior modification group programs (with 125 participants) was compared with 28 individual programs to determine differences in short- and long-term weight loss success. Data were collected directly and via questionnaire during the program and 10 to 36 months after the program. Different factors predicted weight loss during and after program participation, but in neither case was type of program (group vs. individual) significant. When data for the two collection periods were pooled, several factors were identified as significantly related to overall weight loss: (a) Individuals who were more overweight lost more weight. (b) The more prior programs tried the less weight loss occurred. (c) Men participating in group sessions and women seen in individual sessions lost the most weight. (d) The more sessions attended, the greater the weight loss. (e) Attending subsequent programs resulted in greater weight loss. (f) The use of behavioral technique--slow rate of eating--resulted in greater weight loss. (g) Increasing age was associated with less weight loss. The seven variables accounted for almost two-thirds (64%) of the variance.

We have reported a case of hemoptysis caused by pulmonary parenchymal endometriosis which was apparently successfully treated with danazol. Bronchopulmonary endometriosis is a very unusual cause of hemoptysis, and should be suspected on the basis of cyclic hemoptysis with menstruation. Danazol is effective therapy, but information regarding optimal dosage and rates of recurrence after completion of therapy is limited at this time.

Few current studies of the effects of chronic conditions on social functioning examine the effects of disease on the role of homemaker. A major problem confronting researchers in this area is the difficulty in operationalizing dysfunction in social roles other than work roles. In this study we have developed a measure of homemaker functioning based on conceptualizing the homemaker role on two dimensions: the instrumental functions associated with meeting the physical needs of the household and the nurturant dimension concerned with meeting the expressive needs of the household. We used our measure of homemaker functioning to study the effects of rheumatoid arthritis on 142 women, whether employed outside the home or not, between the ages of 21 and 65, all living with husband and/or children at the time of disease onset. The disease significantly limited both instrumental and nurturing functions associated with managing a household. The more strenuous instrumental functions were more likely to be limited, although women in our study experienced serious limitations in nurturant role functions, as well. Limitations in functioning along the nurturant dimension were surprisingly high and previously undocumented. Comparisons between women employed outside the home and those not employed found few differences between the groups in social functioning on either dimension of the homemaker role. Employed women were somewhat less physically disabled than the unemployed, but both groups of homemakers continued to assume major responsibility for homemaking. Assessing functioning in social roles other than work, and functioning in nurturant as well as instrumental areas, is especially important in evaluating the effects on women of a chronic disease such as rheumatoid arthritis.

The efficacy of OKT*3 monoclonal antibody in reversing acute cardiac allograft rejection was investigated in 10 cardiac transplant recipients aged 5 to 57 years (mean 34 +/- 18) and treated with the same induction and maintenance immunosuppression. Serial endomyocardial biopsies, right heart catheterization, and echocardiograms were performed for rejection surveillance. After intensified immunosuppression with equine antithymocyte globulins and steroids, nine patients showed persistent rejection (lymphocytic infiltration and myocyte necrosis). Conventional immunosuppression was contraindicated in one patient. OKT*3 (5 mg by intravenous push daily for 14 days) resulted in complete resolution of rejection in nine of 10 patients (90%). After therapy with OKT*3 mean right atrial and pulmonary arterial wedge pressure were significantly lower (9.1 +/- 4.0 vs 4.8 +/- 2.0 mm Hg and 13.4 +/- 4.3 vs 8.0 +/- 3.3 mm Hg, respectively; p less than .05). Cardiac index was doubled in two patients with rejection-induced cardiac dysfunction (1.5 vs 3.2 and 1.6 vs 2.7 liters/min/m2). Only two patients developed antibodies to OKT*3. Fever, nausea and headache occurred with the first three doses of OKT*3 and did not recur. One patient developed aseptic meningitis. OKT*3 effectively reverses refractory cardiac allograft rejection before the development of irreversible graft dysfunction. Patients who do not develop antibodies to OKT*3 can be retreated with this drug. Adverse reactions to OKT*3 are self-limited.

Seventeen cases of resectable peripheral small cell undifferentiated carcinoma of the lung were studied (average size, 2.1 cm; range, 0.9-3.5 cm). The carcinomas exhibited predominantly mixed intermediate and fusiform/spindle subtypes; in seven carcinomas there were at least some foci of oat cell subtype. There was no histologic evidence of typical carcinoid tumor. Seven cases were fixed in solutions appropriate for immunohistologic study; these exhibited prominent neuron-specific enolase activity but less prominent and more variable staining for the carcinoembryonic antigen and cytokeratins. All 17 cases were deemed resectable and had no clinical or radiologic evidence of metastasis. Seven (41%) patients died with recurrent and/or metastatic carcinoma (average survival, 1.7 years); five of these patients had carcinomas with at least some foci of oat cell foci subtype.