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Syncope is a common clinical problem accounting for up to 6% of hospital admissions. Little is known about resource utilisation for patients admitted for syncope management in Ireland.To determine the utilisation of resources for patients admitted for syncope management.Single centre observational case series of consecutive adult patients presenting to an acute hospital Emergency Department with syncope over a 5-month period.Two-hundred and fourteen of 18,898 patients (1.1%) had a syncopal episode, 110 (51.4%) of whom were admitted. Mean length of stay was 6.9 days. Sixty-four of these admissions were deemed unnecessary by retrospective review when compared to ESC guidelines. Eighty-five (77.3%) admitted patients had cardiac investigations and 56 (51%) had brain imaging performed.Syncope places a large demand on overstretched hospital resources. Most cases can be managed safely as an outpatient and to facilitate this, hospitals should develop outpatient Syncope Management Units.

Background. Precise evaluation of the haemocompatibility of prototype membranes, flow configurations and anticoagulant regimens is an essential step in the development of dialysis systems minimizing blood activation. An ex vivo model in humans currently employed in our laboratory has recently been adapted to allow the parallel evaluation of two minimodule dialysers with blood from a single donor, thus eliminating differences due to donor variability in the comparison of test and control dialysis modules. Methods. The ex vivo flow system is designed to reproduce the haemodynamic conditions of clinical dialysis on a 1/50 scale. A blood line from the forearm vein of the volunteer donor is divided at a Y-shaped junction, two roller pumps assure equivalent blood flow (5 ml/min) in the branches leading to two minimodule dialysers and heparin (0.1 IU/ml final concentration) is injected into each branch immediately after the Y junction. Samples for analysis of blood activation markers are collected at the exits of the two minimodules over a test period of 27 min. In the present series of tests, a new polyacrylonitrile membrane ( PAN ) was evaluated relative to standard commercial polysulphone (PS), acrylonitrile copolymer (AN 69) and cuprophan (CUP) membranes. Results. A steady minimal level of anticoagulation corresponding to a slightly less than two-fold prolongation of APTT (activated partial thromboplastin time) was maintained throughout testing in both branches of the ex vivo flow system. Time curves for the accumulation of activation markers (thrombin-antithrombin III complexes, prothrombin fragment 1+2, platelet β-thromboglobulin, and complement fragment C3a) showed all four types of minimodule dialyser to induce comparable low levels of activation of coagulation parameters and platelets, together with similar mild activation of complement for AN 69, PAN, and PS dialysers as compared to stronger activation for CUP modules. Overall results thus confirmed the acceptable haemocompatibility of the prototype polyacrylonitrile (PAN) membrane. Conclusions. Among current methods for evaluation of the biocompatibility of haemodialysis systems, ex vivo flow models in humans avoid problems arising from species differences and may be designed to closely reproduce the conditions of clinical dialysis. A parallel configuration eliminates artefacts due to individual variations in donor response. This not only facilitates the direct comparison of test and control membranes under close to identical experimental conditions, but also provides a model particularly well adapted to studies of the effects of different anticoagulation regimens, flow configurations, and dialysates, or alternative methods of sterilization, rinsing, and priming of the dialysers.

First year medical students entered school with essentially neutral attitudes towards the elderly in 1986 and 1994 as measured by an Aging Semantic Differential and the class of 1991 entered with significantly poorer attitudes. For all three classes, student's gender, previous exposure to a nursing home or undergraduate curriculum in geriatrics prior to medical school did not affect attitudes at entry into medical school, but older students and those having experience with the elderly had more positive attitudes. Despite growth of the older population and increased attention given to this group over the past decade, medical students' attitudes toward elders did not improve. Since care of the elderly will represent a significant proportion of the future practices of current trainees, and societal changes appear to have insignificant impact on student attitudes toward the elderly, medical schools need to become more proactive in developing curricula to improve such attitudes.

Therapeutic hypothermia (TH) is a process of cooling a patient post ventricular tachycardia/ventricular fibrillation (VT/VF) cardiac arrest to 32-34 degrees C for 24 hours. This improves neurological outcome and is part of current guidelines. Hypothermia prolongs QT interval, which can precipitate torsades de pointes (TdP). We performed a retrospective review of all patients who received TH in our hospital over a period of 2 years to assess the effect of TH on the corrected OT interval (QTc) and any possible pro-arrhythmia. A total of 13 patients received TH. QTc prolonged in all patients with an average of 80.3 + 57.2 ms., and up to 109.8 + 80.4 ms in patients who received Amiodarone concurrently. No TdP was seen in any patient. We conclude that TH is safe, though careful monitoring of the OTc interval is advisable especially with concurrent use of QT prolonging drugs.

Item does not contain fulltext BACKGROUND: The effect of intensified platelet inhibition for patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization has not been delineated. METHODS: In this double-blind, randomized trial, in a primary analysis involving 7243 patients under the age of 75 years receiving aspirin, we evaluated up to 30 months of treatment with prasugrel (10 mg daily) versus clopidogrel (75 mg daily). In a secondary analysis involving 2083 patients 75 years of age or older, we evaluated 5 mg of prasugrel versus 75 mg of clopidogrel. RESULTS: At a median follow-up of 17 months, the primary end point of death from cardiovascular causes, myocardial infarction, or stroke among patients under the age of 75 years occurred in 13.9% of the prasugrel group and 16.0% of the clopidogrel group (hazard ratio in the prasugrel group, 0.91; 95% confidence interval [CI], 0.79 to 1.05; P=0.21). Similar results were observed in the overall population. The prespecified analysis of multiple recurrent ischemic events (all components of the primary end point) suggested a lower risk for prasugrel among patients under the age of 75 years (hazard ratio, 0.85; 95% CI, 0.72 to 1.00; P=0.04). Rates of severe and intracranial bleeding were similar in the two groups in all age groups. There was no significant between-group difference in the frequency of nonhemorrhagic serious adverse events, except for a higher frequency of heart failure in the clopidogrel group. CONCLUSIONS: Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

The contact of flowing blood with an artificial surface leads to adsorption of plasma proteins, followed by platelet adhesion and aggregation and thrombus formation. This phenomenon is enhanced by turbulent flow at joints, bifurcations, and constrictions. In therapeutic plasmapheresis using an IBM blood cell separator, blockage of the extracorporeal circulation system by platelet-fibrin thrombi imposed a halt in treatment for manual clearance of the circuit for 66 in 149 cases (44%). Thus it was decided to passivate the surface of the extracorporeal circuit by filling the tubing with 4% human serum albumin 15-20 min before the treatment session and then displacing the albumin solution with the patient's blood without creating an air-liquid interface. After introduction of this technique, a blockage was observed for only 11 in 239 cases (5%). In vitro measurements of platelet accumulation on the internal surface of the circulation system were carried out using washed human platelets labeled with 111In-oxine in the presence of a 40% hematocrit. Preadsorption of the surface with albumin reduced platelet deposition to 4-5% that observed for an equivalent pretreatment with physiological saline.

We have developed a software system that takes standard electrocardiogram (ECG) input and interprets this input along with user-defined and automatically defined markers to diagnose myocardial infarctions (MI). These pathologies are then automatically represented within a volumetric model of the heart. Over a period of six months 30 patients were monitored using a digital ECG system and this information was used to test and develop our system. It was found that the STEMIs (ST segment Elevation MI) were successfully diagnosed, however NSTEMIs (Non-STEMI), although correctly interpreted, were more ambiguous due to the fact that T wave inversions are sometimes seen on normal ECGs. Control ECGs of normal hearts were also taken. The system correctly interpreted this data as being normal. A standard voxel-count metric was developed so that future work in MI monitoring will be possible. The toolkit was found to be beneficial for three possible uses, as a diagnostic tool for clinicians, as a teaching tool for students and also as an information tool for the patient.

Inflammation is increasingly considered to be involved in the pathogenesis of acute coronary syndromes. We documented persistent elevation in the levels of soluble ICAM-1 and soluble VCAM-1 and a decrease in the levels of soluble E-selectin in the first 72 hours of acute presentation in patients with unstable angina and subendocardial myocardial infarction.

To ensure that the Catholic healing presence remained in the communities it has served for many years, the United States St. Joseph Province of the Sisters of Charity of Montreal (Grey Nuns) is transferring its healthcare institutions to a lay model of sponsorship. The new arrangement makes Covenant Health Systems (CHS) a public juridic person of pontifical right sponsoring the U.S. Grey Nuns' healthcare organizations. In addition to extensive education and communication efforts aimed at all its constituencies, CHS needed to pass through several stages before it could become a public juridic person. Approval had to be obtained from the Grey Nuns Provincial Administration and General Administration (in Montreal). Proposed statutes and bylaws had to be drafted. The CHS Board of Directors had to sign a letter of intent, indicating its willingness to accept these responsibilities of sponsorship. The Congregation for the Institutes of Consecrated Life and Apostolic Societies approved the request for public juridic person status. CHS and the Grey Nuns will take a year to implement the transfer, which will be official on October 24, 1996. CHS will continue to operate in a manner consistent with the teachings of the Catholic Church by complying with the Ethical and Religious Directives and by maintaining contact with local ordinaries.

SummaryA rat thrombosis model was developed to assess the efficacity of antithrombotic drugs. It had the following characteristics: controlled hemodynamic and rheological conditions corresponding to arterial flow, a collagen coated surface as a relevant thrombogenic stimulus, a method of measurement allowing dynamic monitoring of thrombus formation and the possibility to assess the thrombus structure. A shunt composed of polyethylene and silicone catheters, including in the middle of the shunt a collagen coated glass capillary, was inserted between the two primitive carotids of the rat. The duration of patency of the shunt was recorded using a thermic probe fixed on its central part. In this model, the patency of the shunt was 539 ± 55 s. Platelet and fibrinogen-fibrin accumulation in successive one centimeter segments along the shunt were measured using 111In labeled platelets and 125I labeled fibrinogen. Platelet accumulation occurred on the collagen coated surface and at the junctions between the different components of the shunt, where flow was disturbed. The effects of four antithrombotic agents were measured: aspirin, clopidogrel, heparin and r-hirudin. Clopidogrel, heparin and hirudin significantly prolonged patency duration of the shunt, whereas aspirin was inactive. Aspirin did not reduce platelet or fibrinogen-fibrin accumulation on the collagen coated surface. Platelet accumulation on the collagen surface was significantly lower in the clopidogrel group (50 mg/kg) than in the group treated with heparin (500 U/kg), demonstrating the direct antiplatelet effect of clopidogrel. Hirudin at doses giving similar values of APTT as heparin (500 U/kg) prolonged the occlusion time to over 2 h while the heparin occlusion time was only 20 min. We conclude that this experimental arterioarterial thrombosis model is sensitive to both antiplatelet and anticoagulant agents, allowing discrimination between antiplatelet and anticoagulant mechanisms of thrombosis prevention. The technique is easily performed in a small animal, fast and reproducible, and thus comparable to primate models for use in the screening of new antithrombotic drugs.

Adhesion of blood platelets to an injured vessel wall is the first and crucial step in the haemostatic process. Platelet adhesion is also the first step in the development of pathological thrombi when subendothelial structures are exposed to the circulation following endothelial damage and detachment or rupture of an atherosclerotic plaque [1] and the interaction of platelets with disrupted atherosclerotic lesions is the most frequent cause of thrombotic occlusion of coronary and cerebral arteries. Thrombosis of vascular implants and extracorporeal circulatory systems is likewise triggered by platelet adhesion to artificial surfaces in contact with flowing blood [2].

Minimodule hollow fibre dialysers, representing clinical dialysis modules on a scale of 1 25 , enable quantitative evaluation of the haemocompatibility of hollow fibre membranes in an ex vivo flow system in humans. On line heparinization, adjusted for donor sensitivity, is maintained at a minimal level (~0.14 units/ml). Blood samples collected at the minimodule exit over 30 min are analysed for heparin (anti-Xa activity), activated partial thromboplastin time, fibrinopeptide A, platelet count and β-thromboglobulin, complement fragment C3a, leucocyte count and polymorphonuclear neutrophil elastase. Initial experiments were performed using well-characterized reference materials: acrylonitrile copolymer (AN 69 HP), polysulphone and cuprophan (CUP®). Activation of coagulation and platelets was low for AN 69 HF®, intermediate for CUP® and greatest for polysulphone, while complement activation was negligible in the presence of AN 69 HP®, moderate for polysulphone and most important for CUP®. Future applications will be directed towards haemocompatibility screening of prototype membranes with the aim of developing clinical dialysers with improved biocompatibility.

Quantitative evaluation in vitro of platelet accumulation and activation during perfusion with anticoagulated whole blood of biomaterials in catheter form.

Blood interaction with artificial surfaces is largely governed by the first step of the interaction process: adsorption of plasma proteins. Subsequent platelet and leukocyte adhesion and aggregation, activation of the coagulation, fibrinolysis and complement systems and thrombus formation are conditioned by the nature of the layer of adsorbed proteins, in particular its composition and conformational state (Ref. 1, 2).

An investigation was conducted to examine the validity of self reported work histories obtained from a sample of 326 capacitor manufacturing workers who had participated in an epidemiological study relating health abnormalities to exposure to polychlorinated biphenyls. Based on objective personnel records obtained for 288 members of the sample group, validity scores ranged from 20% to 100% with most falling between 70% and 75%. This validity range corresponded to misclassification proportions ranging from 13% to 29%. Exposure misclassification tended to be random for men but non-random for women (overestimation of exposure). By means of multiple regression analysis, the diversity of the job categorical pattern was found to be a significant independent predictor of validity. The factors sex, duration, and time lapse were also significant validity predictors but only interactively with job diversity. There were also indications that interviewer skill could be an important factor. Knowledge of the magnitude of these factor effects could be critical in planning retrospective epidemiological studies.

High school biology students participated in a cardiovascular nutrition education program. The program was evaluated for its effect on the student's knowledge, attitudes, reported eating behavior, and serum lipid levels by matching individual's pre-and post-program results. There was a significant improvement in cardiovascular nutrition knowledge and attitudes toward a low cholesterol pattern of eating. There was also a signigicant improvement in reported eating patterns. However, the rise in serum cholesterol levels one year later did not differ from the rise in serum cholesterol levels in a control school. Improvement in attitudes and reported eating behavior was significantly greater for students whose initial cholesterol level was in the upper quartile of U.S. 16-year olds.

We evaluated 4 treatment regimens using single and multiple injections of epinephrine for the initial treatment of acute asthma in children. Twenty-five patients received 2 injections of epinephrine followed by Sus-Phrine (Group EES) given 20 min apart, 25 received Sus-Phrine only (Group S), 24 received Sus-Phrine followed by 2 placebo injections 20 min apart (Group SPP), and 14 received epinephrine only (Group E). Clinical score and pulmonary function were assessed over a 2-h period. The failure rate was similar in Groups EES, S, and SPP (combined failure rate, 17.8%). The failure rate (46%) in Group E was significantly greater (p < 0.05). The clinical score and pulmonary function was significantly better 5 min after the first injection in Group EES than in Groups S and SPP, but no significant differences were noted thereafter. At 25 min the pulmonary function was similar whether 1 or 2 epinephrine injections were administered. The number of patients exhibiting side effects was significantly greater in t...

Innovation in the field of biomedical technology, involving artificial organs, separation techniques, cell culture and various diagnostic procedures requires the research and development of new materials. These biomaterials must not only meet technological and non-toxicity criteria but must also present a high level of biocompatibility. The latter property depends essentially on interfacial phenomena, since it is through the processes of protein adsorption and cell adhesion that interactions between the material and its biological environment come into play. An illustrative example is the development of haemocompatible materials. The lack of haemocompatible materials represents a real gap in the realization of artificial organs which are to be brought into contact with blood. All synthetic materials possess properties which are able to trigger the coagulation mechanisms. The key events are the adsorption of plasma proteins and the adhesion of blood platelets. Rapid adsorption of proteins leads to the formation of a proteinaceous interface whose composition and structure are strongly dependent on the interactions of the adsorbed molecules with the material. It is generally accepted that it is the changes in adsorbed protein conformation which, by exposing enzymatic sites and providing adhesion sites for platelets, constitute the intitial phase of blood coagulation activation. Thus, the development of haemocompatible materials requires a better understanding of the clotting phenomena initiated at interfaces and of the laws which govern protein adsorption and cell adhesion in relation to the superficial chemical and physical structure of biomaterials.

The reactions involved in the breakdown of C2N2 in a flame of unburnt composition H2/N2/O2=4.5/8/1 have been investigated experimentally by mass spectrometry of the burnt gases and theoretically by computer simulation. Experimentally we find that the C2N2 is converted, by passage through the reaction zone of the flame, into approximately equal amounts of HCN and CO/CO2 mixture. This implies that the main primary reaction: H+C2N2→HCN+CN (13) is followed almost exclusively by CN+O2→NCO+O (15) rather than by CN+H2→HCN+H (14) CO is assumed to be produced from NCO by NCO+O→CO+NO (16) and NCO+H→CO+NH (26) The low yield of NO when C2N2 alone is introduced, and the observed consumption of NO in the reaction zone when both C2N2 and NO are added, are attributed to the reaction NH+NO→products (27) The main alternative reaction CN+NO→N2+CO (21) is too slow to account for removal of NO at the temperature of the early reaction zone. The rate constant for reaction (21) at the temperature of the burnt gas has been determined by measuring the rate of disappearance of HCN above the reaction zone with both C2N2 and NO added, the concentration of CN in this part of the flame being governed by the equilibrium constant of reaction 14. We find k21=7.3×109 m3 kg mol−1 sec−1 at 1500 K. Theoretical concentration profiles of CO and HCN in the reaction zone are consistent with the experimental observations, provided the rate constant for reaction (14) is allowed to increase only slowly with temperature so that it cannot compete effectively with reaction (15). The computer program allows useful numerical predictions to be made concerning the effect of additives such as C2N2 on radical concentrations and burning velocity.

Three hundred sixty-three patients representing two groups of consecutive medical admissions to a large city hospital were evaluated on admission to determine what factors might predict "non-medical" or social stay. Periodic follow-up determined when patients were ready for discharge and when their social stay began. A composite index, the 4-Score, was derived as a simple indicator of risk for subsequent social stay; it is defined as the number of positive answers to the questions: 1) Is the patient 80 years old or more? 2) Will the patient have to live somewhere new at discharge? 3) Is there any disorientation? AND 4) If so, is the disorientation chronic? Eighteen per cent of the total inpatient hospital days of this group of patients could be attributed to social stay. The 56 patients with a 4-Score of two or more on admission had on average a week each of social stay while the 307 patients with a score of less than two averaged only one social day each.

Equilibrium constants for the reaction M ÷ HCN ⇌ MCN + H, where M is an alkali metal atom have been determined by measuring the effect of added C 2 N 2 on the intensity of emission of metallic resonance lines from a fuel-rich, pre-mixed H 2 /N 2 /O 2 flame at 1500 K. The yield of HCN from the cyanogen was measured by withdrawing samples through a quartz micro-probe for mass spectrometric analysis. The enthalpy change of the reaction was calculated by the third-law method. We find D MCN o to be 497, 474, 497, 487, and 501 kJ mol −1 for M  Li, Na, K, Rb, and Cs, respectively, all ± 22 kJ mol −1 .

Analysis of disease-free survival rates in 374 women with operable breast cancer revealed that preoperative weight, particularly in combination with serum cholesterol, is a significant prognostic determinant. Overall, women weighing under 150 pounds had a significantly higher cumulative five-year disease-free survival rate (67%) compared with women weighing more (49%) (z = 2.2298, P = 0.026). Women with low serum cholesterol levels had better cumulative five-year disease-free survival (67%) than women with high serum cholesterol levels (58%) (z = 1.1008, P = 0.27). The combination of high weight and high serum cholesterol levels was associated with an extremely poor cumulative five-year disease-free survival (32%) compared with that observed for women in whom values of either, or both, variables were low (68%) (z = 3.7843, P = 0.0004). These patterns in disease-free survival persisted even after controlling for tumor stage. The findings indicate that weight and cholesterol, in addition to their previously reported effect on the risk of breast cancer development, influence significantly the subsequent course of the disease.

Analysis of five-year disease-free survival rates in 608 women with operable breast cancer revealed that the reproductive history is a significant prognostic determinant. Overall parous women had a significantly higher cumulative five-year disease-free survival rate (60%), compared to the nulliparous (46%) (z = 2.5, p = 0.012). Significant differences were also noted when gravidity in addition to parity was taken as the determinant. The corresponding disease-free survival rates were 61% and 50%, respectively (z = 1.98, p = 0.048). Five-year survival rates were influenced in a similar manner by these variables but the observed differences were less significant. The trend toward higher survival rates in parous and gravidae women were noted in all tumor stages but achieved statistical significance only in stage III. The findings indicate that parity and gravidity affect not only the risk of breast cancer development but also the subsequent course of the disease. Parity seems to be a strong risk and prognostic factor than gravidity.

Plasma androgen sulfates were measured in 92 patients with myasthenia gravis. Plasma androgen sulfates were strongly associated with thymic pathology. The presence of germinal centers was associated with decreased androgen levels. A weak but significant positive correlation existed between androgen sulfates and lymphocyte counts. Low lymphocyte counts in patients with germinal centers were associated with subnormal androgen concentrations. Plasma androgen sulfate levels decreased immediately after thymectomy, but overall no significant differences were found between prethymectomy and post thymectomy levels. A trend toward higher concentrations of plasma androgens was noted 5 or more years post thymectomy. Plasma androgen sulfate levels in myasthenia gravis patients with breast cancer were markedly depressed. The lowest androgen sulfate levels were observed in patients who had previous bilateral breast cancer and those who, subsequent to the determination of the steroid sulfates, developed a second primary lesion of the breast.

SummaryA new technique is described to quantitate platelet deposition in vitro on artifical surfaces, based on a surface phase radioimmunoassay using the monoclonal antibody 6C9, directed specifically against the membrane glycoprotein complex IIb-IIIa of human platelets. Results correlate in linear fashion with those obtained using 111Indium labeled platelets. The method offers particular advantages for the measurement of platelet deposition in whole blood, since platelet separation, washing and labeling procedures are eliminated, together with the ensuing possible selection of platelet populations. In vitro perfusion is performed in glass capillaries of precisely defined diameter (0.80 or 0.56 mm i.d.). Blood flow is laminar and accurately controlled over wall shear rates ranging from venous to capillary (50-4,000 s-1). Using glass capillaries precoated with purified human albumin or fibrinogen or bovine collagen, platelet deposition from suspensions of washed human platelets in Tyrode's-albumin buffer in the presence of a 40% hematocrit is (platelets/mm2): 11,000 (albumin), 78,000 (fibrinogen) and 306,000 (collagen) after 5 min perfusion at 2,000 s-1. In heparin, citrate or hirudin anticoagulated whole blood, surfaces are passivated, probably by albumin adsorption from plasma (platelets/mm2): 400 (albumin), 3,600 (fibrinogen) and 48,000 (collagen) after 5 min perfusion in the presence of 13 mM citrate.

SummaryThe generation of trace amounts of thrombin at artificial surfaces in contact with blood is likely to be a contributing factor in thrombosis on biomaterials. Using an in vitro capillary perfusion system, platelet accumulation on glass surfaces, uncoated or precoated with purified bovine collagen or human plasma proteins, was determined in the presence or absence of preadsorbed purified human thrombin. Static adsorption for 15 min at 22° C from solutions of thrombin 100 NIH units (33 μg)/ml gave surface concentrations in the range 0.019-0.101 μg/cm2. Protein coated capillaries, thrombin treated or untreated, were perfused for 2 min at 37° C with suspensions of washed 111In-labeled human platelets in Tyrode's-albumin buffer containing 40% washed red blood cells, under conditions of controlled, non pulsatile laminar flow (50 s−1 or 2,000 s−1). Platelet accumulation was increased in the presence of surface adsorbed thrombin on uncoated and albumin or fibrinogen coated glass but little affected on fibronectin or collagen coated glass. On von Willebrand factor (vWF) coated glass, thrombin enhancement was observed only at high shear forces. In experiments using antibodies against human platelet α-granule proteins, thrombin stimulated platelet deposition in uncoated glass capillaries was inhibited at 2,000 s−1 by anti-vWF and to a lesser extent by anti-fibrinogen but not by antithrombospondin antibodies.

A health seminar seemed to modify knowledge, attitudes, and reported behavior of a self-selected audience which was already well informed and motivated to change. Therefore, the health seminar appears to be a useful educational approach in this context. The question remains: How can those who are neither informed nor motivated be reached? This study suggests that the public seminar may not be an efficient vehicle for this purpose.

The products of reaction of NO with breakdown products of NH3 in an H2/N2/O2 flame at 1500 K were investigated by mass spectrometric analysis of the hot gases. It is concluded that the major process involving NO and NH is NO + NH → N2 + O + H and that not more than 10% of reactive collisions between these species lead to N2O + H.

The first case, to our knowledge, of consanguinity associated with nemaline myopathy is reported. This is also the first instance of the disorder recorded in Ireland.

A significant association between body weight and estrogen receptor protein (ERP) was noted in 83 women with primary and metastatic breast cancer. Thirteen of 34 (54%) women with weight greater than 150 lb had low or absent receptor protein (less than 10 femtomoles/mg of cytoplasmic protein) compared to 15 of 59 (25%) women with weight less than 150 lb (P less than 0.025). The observed association was stronger in the group of 62 postmenopausal women (P less than 0.01). The findings suggest that the endocrine and metabolic milieu in women with increased weight favors autonomous growth of breast cancer, and adjuvant treatment in this group should be planned accordingly.Body weight, as a parameter to be considered in the treatment of women with breast cancer, was studied to determine any association between it and estrogen receptor protein (ERP) content. ERP was determined in 83 women with primary or metastatic breast tumors. A strong association between ERP and body weight was noted among the 62 postmenopausal women with primary and metastatic tumors. 80% of those with weight equal to or less than 150 pounds had positive ERs, as opposed to only 43% of those of higher weight (P .01). A similar assocation was found among the 56 postmenopausal women with primary breast tumors. The corresponding percentages were 81 and 47 (P .01). There were 21 determinations of ERP among premenopausal women: 13 of 21 (61%) had positive ER as opposed to 42 of 62 (68%) in the postmenopausal group. In all 83 women combined, 11 of 24 overweight women had positive ERP determinations compared with 44 of 59 (75%) with lower weight (P .025).

In evaluating these trends in the East-West comparison, one notes that the epidemiologic features connoting high risk are similar in both cultures; while they are more common in the West, they are more strongly associated in the East. Clearly, a prospective interview method of obtaining reproductive data will be more informative for such a crosscultural study with greater numbers lending better support. In summary, there exists a grouping of reproductive phenomena fairly common in Western societies that are related to higher risk for endometrial cancer, and we have noted similar characteristics in Eastern women who have developed this disease, while control groups in Eastern societies where this disease is uncommon have a low profile for such attributes in comparison to the West.

The relation between mode of therapy and mortality rate and incidence of primary ventricular fibrillation was studied in 265 patients with diabetes mellitus and acute myocardial infarction. Sixty patients were being treated with diet only, 54 were receiving insulin and 151 were taking oral hypoglycemic agents. Fourteen patients (5.3 percent) had primary ventricular fibrillation, and all but one died. No statistically significant association was found between the incidence of primary ventricular fibrillation and the type of treatment for diabetes mellitus. Sixty-four (24.2 percent) of the 265 patients died during hospitalization. Mortality was greater among diabetic patients receiving oral therapy. However, after adjusting for age and sex, the difference among these three treatment regimens did not reach the P less than 0.05 level of significance.

Analysis of disease-free survival rates in 374 women with operable breast cancer revealed that preoperative weight, particularly in combination with serum cholesterol, is a significant prognostic determinant. Overall, women weighing under 150 pounds had a significantly higher cumulative five-year disease-free survival rate (67%) compared with women weighing more (49%) (z = 2.2298, P = 0.026). Women with low serum cholesterol levels had better cumulative five-year disease-free survival (67%) than women with high serum cholesterol levels (58%) (z = 1.1008, P = 0.27). The combination of high weight and high serum cholesterol levels was associated with an extremely poor cumulative five-year disease-free survival (32%) compared with that observed for women in whom values of either, or both, variables were low (68%) (z = 3.7843, P = 0.0004). These patterns in disease-free survival persisted even after controlling for tumor stage. The findings indicate that weight and cholesterol, in addition to their previously reported effect on the risk of breast cancer development, influence significantly the subsequent course of the disease.

ALS is the most common of the various MNDs, which also include the clinical entities of PBP, PMA, and PLS. Mean age of onset of ALS is 57 years, and there is a sex predilection for men in a ratio of 1.5:1. Area of first symptom is in the lower extremity is 36 per cent of cases, in the upper extremity in 32 per cent, and 25 per cent of patients have a bulbar onset. Motor cranial nerves in the lower brain stem from cranial nerve nuclei or corticobulbar tract degeneration are affected. This results in symptoms of speech and swallowing difficulty and emotional lability in up to 60 per cent of cases. One hundred per cent of cases have motor weakness, over 90 per cent have muscle atrophy and fasciculations, and 47 per cent have spasticity. There seems to be a pattern of progression of ALS signs and symptoms based on area of onset with LLE involvement tending to follow RLE weakness, LUE weakness following RUE onset, and RUE involvement following next in patients whose onset is bulbar. Significant numbers of ALS patients had sparing of involvement of parts of the body for follow-up times approaching 3 years. Although the majority of patients experience a deterioration that is significantly linear, seven of 28 patients or 25 per cent achieved a plateau lasting a minimum of 9 months. Survival in our series was 4.08 years for all forms of MND.(ABSTRACT TRUNCATED AT 250 WORDS)

A new technique is described to quantitate platelet deposition in vitro on artificial surfaces, based on a surface phase radioimmunoassay using the monoclonal antibody 6C9, directed specifically against the membrane glycoprotein complex IIb-IIIa of human platelets. Results correlate in linear fashion with those obtained using 111Indium labeled platelets. The method offers particular advantages for the measurement of platelet deposition in whole blood, since platelet separation, washing and labeling procedures are eliminated, together with the ensuing possible selection of platelet populations. In vitro perfusion is performed in glass capillaries of precisely defined diameter (0.80 or 0.56 mm i.d.). Blood flow is laminar and accurately controlled over wall shear rates ranging from venous to capillary (50-4,000 s-1). Using glass capillaries precoated with purified human albumin or fibrinogen or bovine collagen, platelet deposition from suspensions of washed human platelets in Tyrode's-albumin buffer in the presence of a 40% hematocrit is (platelets/mm2): 11,000 (albumin), 78,000 (fibrinogen) and 306,000 (collagen) after 5 min perfusion at 2,000 s-1. In heparin, citrate or hirudin anticoagulated whole blood, surfaces are passivated, probably by albumin adsorption from plasma (platelets/mm2): 400 (albumin), 3,600 (fibrinogen) and 48,000 (collagen) after 5 min perfusion in the presence of 13 mM citrate.

A case-control study of patients ranging in age from 52 to 88 years was done to determine any possible relationship between health factors and senile macular degeneration. Thirty cases and 30 controls were pair-matched according to age, sex, and race. Chart reviews and telephone interviews were the methods of data collection used. The patients were interviewed concerning a history of vascular disease and other health characteristics. The data were analyzed by a paired-sample method. The results of the study showed a definite relationship with age and sex. Moreover, a significant relationship between refractive error and senile macular degeneration was noted. Such an association has not been previously reported. No relationship was found between vascular disease and senile macular degeneration.

We evaluated 4 treatment regimens using single and multiple injections of epinephrine for the initial treatment of acute asthma in children. Twenty-five patients received 2 injections of epinephrine followed by Sus-Phrine (Group EES) given 20 min apart, 25 received Sus-Phrine only (Group S), 24 received Sus-Phrine followed by 2 placebo injections 20 min apart (Group SPP), and 14 received epinephrine only (Group E). Clinical score and pulmonary function were assessed over a 2-h period. The failure rate was similar in Groups EES, S, and SPP (combined failure rate, 17.8%). The failure rate (46%) in Group E was significantly greater (p less than 0.05). The clinical score and pulmonary function was significantly better 5 min after the first injection in Group EES than in Groups S and SPP, but no significant differences were noted thereafter. At 25 min the pulmonary function was similar whether 1 or 2 epinephrine injections were administered. The number of patients exhibiting side effects was significantly greater in the groups receiving epinephrine than in the groups receiving Sus-Phrine only (p less than 0.05). The relapse rates during the 24-h period after the emergency room treatment were similar in Groups EES, S, and SPP (combined relapse rate, 14.3%). We conclude that repeated injections of epinephrine are necessary to sustain bronchodilation but that they do not have a cumulative effect. Furthermore, there is little therapeutic advantage of these repeated injections over a single injection of Sus-Phrine for the initial treatment of acute asthma.