Search

Abstract: A comparative skeletal study was made of the young (10–130 mm) of three closely related species of flounders (Paralichthys dentatus, P. lethostigma, and P. albigutta), which occur along the southeastern Atlantic Coast of the United States. The young flounders are difficult to identify unless the pigment pattern is developed, and this usually does not occur in specimens less than 40 mm long. 149 specimens (10–130 mm) were used in the study, of which 122 (10–60 mm) were cleared and stained. External meristic data were collected and skeletal structures compared by observation and measurement. Most of the adult skeletal characteristics had developed in fishes of 50 mm. Osteologically, vertebral and pterygiophore numbers produced the best separation withP. dentatus having the highest counts andP. albigutta the lowest. Total gill rakers on the first gill arch and lateral-line scales were useful characters with the highest numbers occurring inP. dentatus and the lowest inP. albigutta.

The kinetics of thymidine incorporation into fractionated T lymphocytes responding to bacterial superantigens were compared to those of cells activated by phytohemagglutinin (PHA). Evident differences between the kinetics of cell proliferation induced by PHA-P and staphylococcal enterotoxin B (SEB) emerged after Day 4 of culture. PHA-P-induced proliferative responses of peripheral blood mononuclear cells (PBMCs) and fractionated cells were apparent on Day 4 because of the presence of accessory cells in the initial cell suspensions. This gradually diminished in correlation with the decline of accessory cells in the cultures. The SEB-induced cell growth (PBMCs and CD4+cells), however, continued until Day 9 of the culture. This finding suggests the reciprocal usage of MHC class II molecules to present SEB by activated T lymphocytes for superantigen-induced T cell activation and suggests that superantigen-related immune activation may depend in part on the potential of activated T lymphocytes to mediate reciprocal cell-to-cell interactions in the presence of superantigens. The decline observed in the CD8+cell response to SEB and toxic shock syndrome toxin-1 after Day 4 was revived by exogenous recombinant interleukin-2 (rIL-2) supplementation, suggesting that the consequent autocrine or paracrine secretion of IL-2 from the responding cells is essential for subsequent cell proliferation. SEB-induced cell proliferation was significantly suppressed by anti-CD11a (lymphocyte function-associated antigen-1; LFA-1, α-chain) monoclonal antibody, and the inhibitory effect was most obvious in 6-day cultured CD8+lymphocytes. The results suggest that the lymphocyte response associated with the cell-to-cell copresentation of superantigens involves LFA-1 molecules as an accessory factor, particularly in CD8+lymphocytes.

The effect of oral epidermal growth factor (EGF) on histological and biochemical changes in epithelium in the small intestine was studied in colostrum-deprived neonatal pigs. Forty-eight pigs were infected at 4 days of age with 2 ± 107plaque-forming units of porcine group A rotavirus and orally fed a simulated sow-milk diet supplemented with 0.0, 0.5, or 1.0 mg/L recombinant human EGF. Sixteen noninfected pigs were fed a diet without EGF supplementation. Infected pigs developed severe diarrhea; they also consumed 25 less food and gained 60 less weight than noninfected pigs. Pigs were killed 8 days postinfection to collect samples at seven equidistant points in the small intestine. Rotavirus infection decreased villus height by 37 and reduced specific activity of lactase by 54, of leucine aminopeptidase by 43, and of alkaline phosphatase by 54 in the small intestine, compared with noninfected pigs. Only the supraphysiological dose of EGF (1.0 mg/L) consistently increased villus height in the proximal and mid-small intestine and lactase-specific activity in the mid-small intestine of rotavirus-infected pigs. However, this dose was only partially effective in restoring intestinal mucosal dimensions and enzyme activities. Supplemental EGF did not hasten the resolution of diarrhea. These data indicate that high physiological levels of EGF are beneficial in stimulating recovery of epithelium in the small intestine following rotavirus infection.

In 27 state health agencies, local health liaison units or officials (LHLOs) are formally assigned responsibility for fostering a close working relationship between the state health agency and local health departments (LHDs). Yet in most other states, other agency staff carry out these responsibilities informally. Even where formal LHLOs exist, the assigned functions and specific activities vary, with little consistency across states other than serving as a potential or, in most cases, a real and vital linkage between LHDs and the state agency. This linkage places the LHLO in a unique position to have extensive knowledge, data, and information on LHD activities and to play an important role in assessing and improving local public health practice. This report examines aspects of the LHLO-LHD relationship in terms of potential LHLO roles in LHD practice surveillance and capacity building. Surveys of LHLOs and LHDs indicate thatboth support the development of surveillance tools to measure LHD effectiveness as a means to enhance capacity building efforts. Although LHLOs may not know or have the specific information immediately available to assess local public healthpractice for LHDs in their state, they report being able to obtainthe information if necessary and with sufficient time. Further. LHDs are willing to share information concerning local publichealth practice with their state health department, particularly with their state LHLO. These findings suggest that LHLOs could be extensively involved in surveillance strategies beyond merely collecting and aggregating information provided by LHDs.

The national health objectives for the year 2000 call for 90% of the population to be served by a local health department (LHD) that is effectively addressing the core functions of public health. Achieving this objective requires approved definitions for effectiveness as well as a system for ascertainment. In 1990 when this objective was established, no baseline data were available, and no accepted methods of measuring health department effectiveness were in use. Our approach to the development of a surveillance system to measure the effectiveness of LHDs has been to translate the three core public health functions characterized by the Institute of Medicine and the 10 practices delineated by the Centers for Disease Control and Prevention (CDC) and the national public health practice organizations into practice performance measures that could be judged as met or not met at the level of a jurisdiction served by a LHD. As part of our effort to develop a surveillance system to measure local public health practice, performance measures that characterize the 10 public health practices and their related core functions were developed and field-tested with state local health liaison officials and local health departments over a two-year period. Obtaining input from these sources is essential to establishing their validity and is a critical aspect of building nationwide consensus for appropriate measures of effective local public health practice. The results of these efforts led to the establishment of a proposed surveillance instrument comprising 10 performance standards and 29 associated indicators. We describe two approaches to its use.

The majority of Australia's universities and many colleges of advanced education now have tertiary teaching units. Existing statements, such as the Australian Vice-Chancellors' Committee published guidelines for the setting up of tertiary teaching units have failed to suggest appropriate models for teaching units or to propose adequate criteria for evaluating existing units.In the present analysis the functions of tertiary teaching units are examined. Six models for tertiary teaching units are identified together with suggested criteria for evaluating the effectiveness of such units.

OBJECTIVE:To evaluate the rate of specific pathogens and clinical syndromes associated with acute respiratory tract infections (ARTI) in frail older persons attending daycare.

An unusual outbreak of measles occurred in 1982 in a pediatrician's office in Muskegon, Mich. Three children, who had arrived at the office 60 to 75 minutes after a child with measles had departed, developed measles. Using a model based on airborne transmission, it is estimated that the index patient was producing 144 units of infection (quanta) per minute while in the office. Characteristics such as coughing, increased warm air recirculation, and low relative humidity may have increased the likelihood of transmission. Adequate immunization of all patients and staff, respiratory isolation and prompt care of all suspected cases, and adequate fresh-air ventilation should decrease the risk of airborne transmission of measles in this setting. Airborne transmission may occur more often than previously suspected, a possibility that should be considered when evaluating current measles control strategies.(JAMA 1985;253:1574-1577)

From December 10, 1982, to March 4, 1983, when influenza A (H3N2) viruses circulated in Michigan, outbreaks of influenza-like illness were identified in seven nursing homes in Genesee County; 272 (27%) of 1,018 residents were affected. Unvaccinated residents were more likely than vaccinated residents to become ill (risk ratio [RR], 2.6; 95% confidence interval [CI], 1.8-3.6) and were subsequently more likely to be hospitalized (RR, 2.4; 95% CI, 1.2-4.8), develop roentgenographically proven pneumonia (RR, 2.9; 95% CI, 1.6-5.3), or die (RR, 5.6; 95% CI, 1.2-9.1). Similar observations were made during investigations in six of the eight remaining nursing homes in Genesee County, in which 57 (12%) of 458 residents became ill sporadically. These findings suggest that influenza vaccine can reduce the incidence and severity of influenza virus infections among the elderly and chronically ill and underscore the importance of vaccination programs for those in nursing homes and in the general community.(JAMA 1985;253:1136-1139)

One of Australia's newest educational technology units is the Advisory Centre for University Education at the University of Adelaide. It is concerned with all aspects of teaching and learning in the university. This article describes how the Centre is interpreting this role.

Abstract:  To understand the mechanisms involved in the pathogenesis of human T lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP), three in vivo phenomena which have been observed in the peripheral blood of patients and differing from that in asymptomatic HTLV-I carriers must be taken into consideration: (a) the presence of increased HTLV-I viral load, (b) a higher immune responsiveness against HTLV-I antigens, and (c) biased nucleotide substitutions in the HTLV-I pX region which indicate a decreased selection pressure for viral amino acid changes. We now propose a hypothesis which focuses on the in vivo dynamics of HTLV-I infected lymphocyte migration and which incorporates these features. In addition, the hypothesis assumes the existence of a deviation in immune surveillance for HTLV-I in the central nervous system (CNS) in spite of the presence of frequent specific immune effectors. We suggest that in the active phase of HAM/TSP, accompanied with or following autoaggressive interactions between infected lymphocytes and immunocompetent cells in the CNS, there is a consequential reflux of the infected lymphocytes to the peripheral blood. The reflux of infected cells would be expected to provide peripheral blood with tissue-derived HTLV-I proviruses which have been indulged and propagated in an immune-privileged site. This process would result in and account for the observed increase in viral load and the substitution bias in HTLV-I sequences in the peripheral blood.

A micromethod using reversed-phase high-performance liquid chromatography for the analysis of vancomycin in human serum or plasma was developed. Ristocetin was used as the internal standard. Chromatographic conditions included an amino propyl column, a mobile phase with 62 acetonitrile and 38 sodium phosphate buffer (pH 7.0), a total run time of 10 min, and ultraviolet absorbance detection at 225 nm. Multilevel calibration was found to be linear between 1.0 and 100 μg/ml with correlation coefficients of the calibration line slope consistently >0.999. Recovery of vancomycin from serum was nearly complete, and no interference from commonly used drugs was observed. This procedure is simple, sensitive, rapid, precise, selective, and requires only 50 μl of serum or plasma for completion.

Weanling Fischer 344/N (F344) rats and the first filial hybrid of C57BL/6 × C3H (B6C3F1) mice and retired breeders from the parental stocks of these strains were monitored over a 5-yr-period by examining the histopathology of selected organs and comparing those results to viral and mycoplasmal serology and the intestinal tract bacterial flora of each animal on an individual basis. Serology gave no evidence of viral infection, but Mycoplasma arthriditisantibodies were detected. Reactivity of serum of adult C57BL/6 female mice with control cells or media (tissue culture, TC) was seen in a significant number of mice. TC reactivity correlated positively with lymphoid perivascular infiltrates, predominantly of the lungs, suggesting an allergic response in development of the lesions. Other lesions of note consisted of Harderian gland inflammation of rats, focal necrotizing lesions of the liver of both species, and thickening of the pleura and adjacent pulmonary interstitium of weanling rats. Embolization of bacteria from the gastrointestinal tract to the liver was considered a possible cause of the liver necrosis in both species. Although lesions of the lung and Harderian gland of the rats are similar to those caused by known viral agents, the cause of the latter could not be determined as these animals were negative for viral antibodies and the former was considered to be related to incomplete pulmonary development in the young rat. Features differentiating the lesions observed in animals of this survey from those caused by viral infection are discussed.

Prologue:As the pursuit of health care reform has accelerated, policymakers have become fascinated with the record of Rochester, New York, in moderating the growth of its health care expenditures and providing broader access to services than is the case nationally. No single feature of Rochester' s health care system is responsible for the community's performance, but as authors William Hall and Paul Griner document, many forces have been at work to achieve this level of success. These forces include a long history of community-based health planning, with strong private corporate involvement, which helped to limit the expansion of hospital capacity and to control the diffusion of expensive medical technology. Another important feature has been the role of Rochester Blue Cross and Blue Shield, which insures more than 70 percent of area residents. Became of the commanding market position of the Blues, community rating —basing premiums on the experience of the entire community rather than the demographic characterics or health status of smaller groups of enrollees —has been maintained, and that has kept the cost of care affordable for more people. Hall is a professor of medicine at the University of Rochester School of Medicine and Dentistry. His chief professional interests are in continuing medical education, the use of automated information management technology, and geriatrics. Griner is Samuel E. Durand Professor of Medicine there and is chief executive officer of Strong Memorial Hospital, a 715-bed teaching institution. Griner, president of the American College of Physicians, is perhaps best known for his long-standing efforts to educate physicians to develop more cost-effective ways to diagnose illness and manage patients.Abstract:Rochester, New York, has been cited repeatedly for having achieved one of the most cost-effective and efficient health care systems in the country. The determinants of the success of this system include a long history of comprehensive health planning; innovative hospital reimbursement programs; community-rated health insurance; and high levels of mutual cooperation among business, insurers, hospitals, and physicians. The Rochester system promotes the goals of access, quality, affordability, and provider satisfaction through a balanced approach to regulation and competition.

• The prevalence of Q fever infection is probably underestimated. In Michigan, the first two reported human cases of Q fever occurred in 1984. The case-patients lived in adjacent, rural counties and had multiple exposures to goats. We conducted a serosurvey of goat owners and a reference population to compare the prevalence of Q fever antibodies in the two-county area. Goat owners were almost three times more likely to be seropositive with Q fever antibodies than the reference population (43% vs 15%). Among goat owners, individual and household seropositivity prevalences were positively correlated with the number of goats, the number of positive goats, and the number of goat births on the farm. Q fever should be considered more often in the differential diagnosis of patients with compatible illness, especially those with frequent animal contact.(Arch Intern Med 1988;148:609-612)

Immunohistochemistry has been utilized in recent years primarily for diagnosis of infectious diseases of the liver, especially in humans. The utility of immunohistochemistry has extended to experimental and toxicologic pathology in a variety of areas: identification of cell phenotype, cell receptors, cytokine and chemikine production, and functional cell changes such as enzyme induction. In addition, markers for experimental carcinogenesis studies are detectable by immunohistochemical changes as well as novel antigen induction such as placental glutathione-S-transferase, oncofetal proteins, oncogene products, and typing of neoplasms. Immunohistochemistry is also used to detect the origin and function of various cell types in developmental and toxicity studies. Careful use of immunohistochemical procedures in conjunction with routine pathology and molecular techniques enhance the ability of the toxicologic pathologist to diagnose unique conditions and to understand mechanisms of lesion development.

Five unique fluorinated analogs, 8acand 15a,b, of the monoamine oxidaseA inhibitor 3isopropoxyphenoxathiin 10,10dioxide II were prepared viaoxidation of the corresponding phenoxathiins 7and 14. 3Fluoro7isopropoxy 7a, 2fluoro3isopropoxy 7b, and 2,7difluoro3isopropoxyphenoxathiin 7c were prepared by a modification of the Mauthner synthesis which involved cyclization of the corresponding 2hydroxy4isopropoxythiophenols 4with the appropriate 2halonitrobenzenes 5in the presence of potassium tertbutoxide. Preparation of 2,8difluoro3isopropoxyphenoxathiin 14b from 4band 2,4difluoronitrobenzene 5c employing similar methods failed, leading instead to a novel macrocycle 9. Attempts to obtain 2fluoro7isopropoxyphenoxathün 14a and the 2,8difluoro analog 14bviatrifluoroacetic acid deprotection of intermediate thioprotected 2nitrophenyl 2thiophenyl ethers 11aand cfollowed by cyclization of the resulting thiols were also unsuccessful. Deprotection of 11awith trifluoroacetic acid produced only complex product mixtures, while similar deprotection of 11cand treatment of the resulting crude product with potassium tertbutoxide in refluxing dimethylformamide produced the 2,7difluorophenoxathiin analog 7c, a result consistent with a Smiles rearrangement of the intermediate thiol 12prior to ring closure. The phenoxathiins 14were ultimately prepared by a modification of a relatively unexploited phenoxathiin synthesis involving the intramolecular radical substitution at sulfur of 2aminophenyl 2thiophenyl ethers 13containing paramethoxybenzyl and methoxymethylthioprotecting groups.

We established 99 JC virus (JCV) DNA clones directly from the brain of a single patient with progressive multifocal leukoencephalopathy (PML). Based upon restriction patterns, the cloned viral DNAs were classified into two major groups (NY-1A and -1B) containing 53 and 35 clones, respectively, and several minor groups containing one or a few clones. The regulatory sequences of representative clones were compared with the archetypal regulatory sequence, which has been detected in JCV DNAs cloned from the urine of healthy and nonimmunosuppressed individuals. The regulatory sequence of NY-1B had the two structural features common to most PML-type regulatory regions, duplication and deletion of specific segments in the archetypal sequence, while that of NY-1A contained a small deletion and an insertion of a 29-bp sequence originating from the early region of the JCV genome. A regulatory region similar to that of NY-1A has never been detected in JCV isolates obtained thus far.

During studies of swine influenza virus (A/NJ/76) infection, a technique was devised to quantify the pulmonary lesions in infected mice treated at different time intervals with antiviral chemotherapeutic agents. The technique is based on the premise that as the severity of microscopic change increases, the optical density of lung sections also increases because of edema and increased cell numbers in infected lungs. Seven days after intranasal instillation of the virus, mice were killed and the lungs were perfused with 2% glutaraldehyde at constant pressure. Lungs were processed in a routine manner, sectioned at standard levels, and stained with hematoxylin and eosin. By using standard photomicrography equipment, multiple optical density measurements were made of lung sections in a carefully controlled systematic manner, and a mean optical density was determined for each lung. The optical density of lungs of mice treated before and after infection with amantadine, rimantadine, or ribavirin was significantly reduced compared with that of the lungs of infected, untreated controls. If treatment was delayed until 15 h after infection, amantadine and ribavirin were effective in reducing pulmonary optical density, but rimantadine was without effect. These findings correlated well with mean lung weight of each group; however, the sensitivity of the optical density technique was greater. Subjective scoring of microscopic lesions revealed differences only between infected and uninfected controls. The densitometric method offers promise as a reliable means of objectively quantifying the pulmonary response to a variety of infectious, toxic, and therapeutic agents.

While considerable information is available on the pathogenesis of human T lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP), fundamental questions remain unanswered. In particular the clinicopathological uniformity of the disorder among patients remains poorly understood. The potential role of TGF-β as a preferential immune regulator in the CNS and the functional heterogeneity of TGF-β has led us to assess the possible involvement of this cytokine in the pathogenic process. To investigate this, the modulatory effects of TGF-β1 on HTLV-I-induced in vitro phenomena were evaluated using fractionated lymphocytes from patients with HAM/TSP. It could be shown that the proliferative response of CD8⁺ cells against cultured and irradiated autologous CD4⁺ cells possessing HTLV-I antigens was significantly inhibited by TGF-β1. However, the in vitro activation of HTLV-I, which was evaluated by spontaneous proliferation of CD4⁺ cells, was unaffected by TGF-βI. The induction of intracytoplasmic HTLV-I antigens in cultured CD4⁺ cells was facilitated by TGF-β1 in a dose-dependent manner. These findings suggest that TGF-β may have a critical role in localized viral activation within the CNS in patients with HAM/TSP. Copyright 1995, 1999 Academic Press

OBJECTIVE:To evaluate the incidence and impact of rhino‐virus and Coronavirus infections in older persons attending daycare.

The effect of ribavirin aerosol on experimental respiratory syncytial virus (RSV) infection was evaluated in a double-blind controlled study of 16 young adult volunteers. Two days after intranasal inoculation with RSV, half of the subjects were treated with a small-particle aerosol of ribavirin and half with placebo for a total of 12 hours each day for three days. Seven of eight placebo-treated and six of eight ribavirin-treated subjects became infected. Viral shedding was diminished in the ribavirin-treated group. The proportion of infected volunteers still shedding virus on days 6 through 9 was significantly less than in the placebo-treated group. Ribavirin appeared to have no effect on minor upper respiratory tract signs, but systemic complaints and fever occurred significantly less often in the ribavirin-treated group. Ribavirin aerosol therapy was well tolerated and produced no significant changes in pulmonary function test results or signs of toxicity. This suggests that such therapy might be further evaluated in infants with RSV lower respiratory tract disease.(JAMA 1983;249:2666-2670)

• The physiological abnormalities and clinical correlates of 32 infants consecutively hospitalized with lower respiratory tract disease from respiratory syncytial virus (RSV) were studied in an attempt to characterize the infant most at risk for the acute and long-term complications of RSV infection. Arterial oxygen saturation (Sao2) determinations were obtained daily by means of an ear oximeter. On admission all infants were hypoxemic with a mean Sao2 of 87% (range, 74% to 95%). The mean of the lowest Sao2 recorded during their hospitalization was 85.5% (range, 53% to 96%). The hypoxemia improved little during hospitalization but showed improvement three to seven weeks later. The severity of the hypoxemia correlated significantly with the duration of viral shedding, occurrence of apnea, respiratory rate, age, and percentage of immature neutrophils. Clinical severity did not correlate with the degree of hypoxemia.(Am J Dis Child 133:798-802, 1979)

• Fullness developed in the left side of a 5-month-old male infant's face in the region of the zygoma. An incisional biopsy specimen showed the mass to be a melanotic neuroectodermal tumor, and radical excision was performed. There has been no recurrence of the tumor one year later. Tumors of this type occur in the face, particularly in the maxilla. and have only rarely been reported around the orbit.

Five normal volunteers and five patients with duodenal ulcer (DU) disease were studied for five consecutive nights. All subjects underwent placement of a nasogastric tube, continuous collection of gastric juice, and continuous electroencephalographic monitoring of sleep. Gastric juice was collected in 20-minute samples by remote suction (Gomco). Blood samples were drawn every 20 minutes on the third night via an indwelling venous needle. Results showed no significant correlations between the sleep variables and the gastric acid secretion measures or between the sleep variables and serum gastrin levels. Acid secretion decreased from hour 1 to hour 2 in controls and in patients with inactive DU disease, while it increased in patients with active DU disease. Each subject had at least one night of recording in which continuous gastric secretion was less than 0.1 mEq per 20-minute sample. It appears unlikely that the gastric discomfort of DU patients can be attributed to acid hypersecretion triggered by rapid eye movement sleep.(Arch Intern Med 136:655-660, 1976)

Fumonisin B1 (FB1), a recently identified mycotoxin produced by Fusarium moniliforme in corn, has been shown to cause death in swine due to pulmonary edema, an apparently species specific effect, and to interfere with sphingolipid metabolism in vitro. Here we characterize the toxicity of fumonisins, using female cross-bred swine weighing 6 to 13 kg, and present a hypothesis regarding the mechanism of fumonisin-induced pulmonary edema in swine. FB1 was given daily intravenously (IV) to pig 1 for 9 days for a total of 72 mg (7.9 mg/kg) and to pig 2 for 4 days for a total of 67 mg (4.6 mg/kg). Pig 3 (control) was given saline IV for 9 days. Corn screenings naturally contaminated with FB1 (166 ppm) and FB2 (48 ppm) were fed to pigs 4, 5, and 6, and ground corn was fed to pigs 7 and 8 (controls). Pigs 4 and 7 were killed on day 5; pig 5 was found dead on day 6; and pigs 6 and 8 were killed on day 15. Pigs 4 and 5 had ingested 187 and 176 mg total fumonisins, respectively, while pig 6 had ingested 645 mg. Feed consumption had decreased in pigs fed corn screenings, with an additional sharp decrease prior to onset of clinical signs. Increases in serum liver enzymes, total bilirubin, and cholesterol were present, but electrocardiograms, heart rate, and body temperature were unaffected. Pigs dosed IV with FB1, developed mild intermittent respiratory abnormalities, while those fed screenings developed respiratory distress within 5 days. Mild interstitial pulmonary edema was observed in pig 1. Severe interstitial pulmonary edema, pleural effusion, and increased lung wet/dry weight ratio were observed in pigs 4 and 5. All pigs given fumonisin (either IV or orally) had hepatic changes characterized by hepatocyte disorganization and necrosis; pancreatic acinar cell degeneration was also observed. Ultrastructural changes in orally dosed swine included loss of sinusoidal hepatocyte microvilli; membranous material in hepatic sinusoids; and multilamellar bodies in hepatocytes, Kupffer cells, pancreatic acinar cells and pulmonary macrophages. Pulmonary intravascular macrophages (PIMs) contained large amounts of membranous material. Thus, the target organs of fumonisin in the pig are the lung, liver, and pancreas. At lower doses, slowly progressive hepatic disease is the most prominent feature, while at higher doses, acute pulmonary edema is superimposed on hepatic injury and may cause death. We hypothesize that altered sphingolipid metabolism causes hepatocellular damage resulting in release of membranous material into the circulation. This material is phagocytosed by the PIMs thus triggering the release of mediators which ultimately results in pulmonary edema.

Fumonisin is a recently identified mycotoxin that has been shown to be the cause of pulmonary edema disease in swine and leukoencephalomalacia in horses. Mystery Swine Disease (MSD), is an economically devastating disease complex of unknown etiology that has been reported to have occurred in several swine producing states since 1988. To determine the relationship between MSD and fumonisin, a case-control study was carried out in Illinois in mid-1990. Feed samples collected from 12 case and 9 control farms were analyzed for fumonisin. Sera from swine on all farms was screened for titers against encephalomyocarditis (EMC) virus and concentrations of alpha-1 acid glycoprotein (an acute phase reactive protein). Fumonisin concentrations ?20 ppm were found on 1 control farm (1/9) and 8 case farms (8/12). Titers against EMC virus (? 1:16) were found on 5 control farms (5/9) and on 6 case farms (6/12). Farms with ?20 ppm fumonisin in the feed were at significantly increased risk (OR= 11.2, Fisher's exact test p=0.037) for MSD. Furthermore, the p2 test for trend was significant (p= 0.017), meaning that as the level of fumonisin in the feed increased, the risk of MSD also increased. The presence of EMC virus titers in the sow herd was not a significant risk for MSD (OR =1.25, Fisher's exact test p=0.75). Alpha-1 acid glycoprotein concentrations obtained from 2-week old nursing pigs differed significantly (p=0.0005) between MSD case and control herds.

Fumonisin B1 (FB1), a mycotoxin produced byFusarium moniliforme andF. proliferatum, induces liver damage and pulmonary edema in swine. We examined the temporal and dose-response features of FB1 toxicosis in male weanling crossbred pigs fed nutritionally balanced diets, containing corn screenings naturally contaminated with fumonisins, for 14 days. Total fumonisins (FB1 and FB2) in diets 1 through 6 were assayed at 175, 101, 39, 23, 5, and <1 ppm (below detectable concentrations), respectively. Clinical signs, serum biochemical alterations, and morphologic changes were evaluated. Pigs were weighed, and bled for hematologic and clinical chemistry evaluation on days 5 and 14. They were euthanized on day 14, or earlier if respiratory distress was observed. Respiratory distress developed in 3/5 pigs fed diet 1 between days 4 and 6 due to severe pulmonary edema and pleural effusion. Histologic evidence of hepatic injury was present in all pigs fed diets 1 and 2, 3/5 on diet 3, and 1/5 on diet 4. Serum bilirubin and cholesterol concentrations, gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and arginase (ARG) activities were elevated in pigs fed diets 1 and 2. Based on liver histopathology, the no observed adverse effect level (NOAEL) for fumonisin toxicity in swine was <23 ppm total fumosins for the 14-day period. Based on regression analyses of the clinical chemistry profiles at 14 days, the NOAEL was <12 ppm, with ALP being the most sensitive parameter. In conclusion, pulmonary edema occurred only at the highest fumonisin concentration (175 ppm), while liver damage occurred at much lower concentrations with a NOAEL of <12 ppm.

In an effort to make pharmacy a more patient oriented health profession, pharmacy students at the University of Pittsburgh are required to take a course entitled, Social Sciences in Pharmacy. Besides drawing from the diverse social and behavioral sciences this course also includes material from the field of social work. This article describes the course and the students' reactions to it. It also provides an overview of some of the recent trends in the field and suggests areas where consultation between pharmacist and social worker may be indicated.

AbstractObjective:To study an increase of antimicrobial-resistant Acinetobacter baumanniiand to assess reasons for the delayed detection of this increase.Design:Review of medical, laboratory, and infection control records. Plasmid profile analysis of available Abaumannii isolates.Setting:A 340-bed trauma and intensive care hospital in Detroit, Michigan.Results:The number of hospitalized patients with resistant Abaumannii increased during late 1989 and early 1990: 4 in September, 10 in October, 12 in November, 18 in December, and 23 in January (chi square for trend = 14.6, p= .0001). Forty-four (66%) of the 67 patients culture-positive for resistant A baumanniihad respiratory tract colonization or infection. Of 11 resistant isolates, 6 had a similar plasmid profile and 5 had no plasmids. Under the hospital's targeted surveillance system, only positive cultures from blood or wounds were investigated; this largely respiratory increase of resistant A baumannii went unrecognized until January 1990.Conclusions:Antimicrobial resistance in A baumannii is an important concern. Such resistance is not necessarily plasmid mediated. Tar geted surveillance for this and other agents of nosocomial infection should be used with caution, particularly in hospitals with many debilitated patients.

Proposals for dealing with illegal migration from Mexico to the United States generally do not recognize it as an international social problem. The proposals also present contradictory solutions. Amnesty, a humanitarian policy, is being suggested as well as incresaed restrictions and punishments, a policing policy. However, in the absence of a comprehensive national policy, community social and health care programs must provide services to illegal aliens. This article attempts to document some of the issues that illegal immigration presents for community agencies.

In almost all discussions of the processes of organizational planning and policy formulation, one is eventually confronted with two contradictory points of view. On one side are the “rationalists,” who conceptualize the planning process by postulating a set of theoretical premises, analytical techniques, and organizational relationships which can be linked together to achieve a formally structured, logical system of policy formulation. Parties supporting this view typically argue that the planning process can be improved by the development of new theories and analytical tools to implement such a normative system. On the other side are the “intuitionalists” those promoting this viewpoint generally start with a list of “horror” stories pointing out the deficiencies, nonuses, and misuses of the socalled rational systems. These parties generally reach the conclusion that more skill and more judgment — not formal approaches or new analytical methodology — are the essential elements in improving the planning process.

Jenny Cook-Gumperz. Social Control and Socialization: A Study of Class Differences in the Language of Maternal Control. Primary Socialization, Language and Education Series. London: Routledge and Kegan Paul, 1973. xii + 290 pp. Figures, appendix, bibliography, and index. $16.95.

PURPURA URPURA fulminans is a disorder characterized by the sudden onset of peripheral, symmetrical, apparently hemorrhagic lesions which usually become gangrenous. It is reported most often as a sequela of β-hemolytic streptococcal infections or any of several other conditions, including meningococcemia, pneumococcal sepsis, varicella, pregnancy, and myocardial infarction.1-3 This is believed to be the first report of purpura fulminans in association with infection by β-hemolytic streptococci of Lancefield group B (Streptococcus agalactiae). REPORT OF A CASE The patient (BCH 382522), a 78-year-old Polish confectionary seller, entered the hospital on Aug 11, 1963, acutely ill with the chief complaint of being "sick." It was learned that he had been discharged eight days previously from another hospital with diagnoses of (1) arteriosclerotic heart disease, (2) chronic brain syndrome, (3) degenerative arthritis, and (4) benign prostatic hypertrophy for which he had undergone a transurethral resection. There was no history of rheumatic fever,

As for man, his days are as grass; as a flower of the field, so he flourisheth; the wind passeth over it, and it is gone....—Psalm 103. 15, 16.Reminiscent of this ancient Psalm was the awesome, catastrophic course of infection in the patient described below—an infection new to our clinical experience and a type infrequently reported in the literature. REPORT OF A CASE The patient was a previously vigorous 62-year-old white man who apparently had been ill and in bed for about a week. He was thought to have fallen, scraping his left arm, at the outset of this illness. He was finally brought to the hospital because he looked poorly and had become confused. The family had noted that his left arm was swollen and weeping on the day of admission. The admitting diagnosis was a "burn" of the left arm. Except for loss of weight

Consider a queueing system of the following type: random arrivals enter the system, where they are assigned to one of rservice channels. Each arrival is then serviced and discharged from the system. The classical results for this class of problems are based upon systems where customers join a single queue and then are randomly assigned to an available server from this queue. (See, for instance, Takács (1962).)

Twenty-seven lines of murine tissue cultures derived from 12 different cell pools and grown on various media were examined with the electron microscope for morphologically detectable virus particles. They were also tested for complement-fixing mouse leukemia virus antigens and for recoverable virus. A 100-percent correlation between results obtained by these two methods is reported. An additional 19 lines from 8 different cell pools were examined for either virus particles or complement-fixing antigens. All lines were assayed for neoplastic transformation. Seven cell pools gave rise to lines showing evidence of contamination with leukemia virus. Since most of these lines had also undergone "spontaneous" neoplastic transformation in vitro, this virus cannot be excluded as a possible cause of the neoplastic change, or of influencing it. The remaining cell pools gave rise to lines with no evidence of contamination with leukemia virus; but most of these lines also underwent similar transformation. These results suggest that "spontaneous" neoplastic transformation can occur in the absence of detectable mouse leukemia virus.