Recent Trends in the Management of Life-Threatening Ventricular Arrhythmias

An edited summary of an Interdepartmental Conference arranged by the Department of Medicine, UCLA School of Medicine, Los Angeles. William M. Pardridge, MD, Associate Professor of Medicine, is Director of Conferences.This study was supported in part by grants from the Public Health Service; the National Institutes of Health (HL-23970, 1978-1981); the Medical Research Service of the Veterans Administration, and the American Heart Association, the Greater Los Angeles Affiliate.     

Percutaneous fine needle aspiration biopsy of the lung. A study of 1,015 patients

From the time of its introduction, in 1973, through November 1983, fine needle aspiration biopsy ( FNAB ) of the lung was used in the diagnostic evaluation of 1,015 patients at the Duke University Medical Center and Durham Veterans Administration Medical Center. A diagnosis of a primary lung cancer was established in 49.4% of the cases and malignant neoplasm metastatic to the lung in 14.1%; a benign diagnosis was made in 31.1% and an inconclusive one in 5.4%. In 123 patients in whom lung tissue was also available, cancer was correctly diagnosed by FNAB in 83.8%, not diagnosed by FNAB in 14.6% and incorrectly diagnosed in 1.6%. In 37 patients without cancer, FNAB detected an infectious organism or a specific morphologic type of inflammation (abscess and granuloma).     

A randomized clinical trial of remission induction,consolidation, and chemo-immunotherapy maintenance in adult acute myeloblastic leukemia

Summary The Southeastern Cancer Study Group conducted a randomized clinical trial in acute myeloblastic leukemia and the blastic phase of chronic myelocytic leukemia to compare: Two induction programs (Schedule A) cytosine arabinoside and 6-thioguanine or (Schedule B) cytosine arabinoside, 6-thioguanine and daunorubicin; two consolidation programs (Schedule C) continuation of induction programs at a reduced dose or (Schedule D) a combination of cyclophosphamide, methotrexate and vincristine; and two maintenance programs — (Schedule E) 1 month of BCG, followed by methotrexate or (Schedule F) methotrexate. Over a 3 year period 372 patients were entered and 295 were judged evaluable. None of 11 patients with blastic phase of chronic myelocytic leukemia responded. There were no significant differences between the schedules in the number of patients with acute myeloblastic leukemia achieving complete remissions (37%, Schedule A vs. 41% Schedule B). The relapse rates on consolidation were similar (43%, Schedule C and 39%, Schedule D). BCG significantly prolonged the duration of first remission following consolidation (P<0.05) from 13.0–23.9 weeks. Survival was not significantly prolonged (92.7 weeks vs. 71.7 weeks). There were no serious complications from BCG therapy. Contributors. The following members of the Southeastern Cancer Study Group participated in this study: John T. Carpenter, John R. Durant, Richard Gams, William J. Hammack, George A. Omura, Gayle Roberts, University of Alabama School of Medicine, Birmingham, Alabama; Harold Silberman, Donald S. Miller, Duke University School of Medicine, Durham, North Carolina; William B. Kremer, Durham Veterans Administration Hospital, Durham, North Carolina; Evert A. Bruckner, Lawrence E. Cooper, Charles C. Corley, Joseph E. Hardison, Charles M. Huguley, Jr., James Keller, Mason G. Robertson, John D. Schmale, Charles Vogel, W. R. Vogler, William H. Whaley, E. F. Winton, Emory University School of Medicine, Atlanta, Georgia; Chan Kon Chin, Guy Faguet, Claude-Starr Wright, Medical College of Georgia, Augusta, Georgia; Y. S. Ahn, Howard E. Lessner, University of Miami School of Medicine, Miami, Florida; Dov Gorshein, Scott Murphy, Presbyterian University of Pennsylvania Medical Center, Philadelphia, Pennsylvania; William E. Barry, Sharon P. Fischer, Rosaline R. Joseph, Richard V. Smalley, Temple University School of Medicine, Philadelphia, Pennsylvania; Virgil Loeb, Jr., Cary Presant, Edward Reinhard, Shabbir H. Safdar, Washington University School of Medicine, St. Louis, Missouri; Norman Maldonado, Enrique Velez-Garcia, University of Puerto Rico School of Medicine, San Juan, Puerto Rico; S. A. Gregory, William H. Knospe, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois; Stephen Krauss, University of Tennessee Memorial Research Center, Knoxville, Tennessee; Karl Tornyos, New Orleans Veterans Hospital, New Orleans, Louisiana; W. B. Forman, R. W. Kellermeyer, A. Rassiga, Case Western Reserve University School of Medicine, Cleveland, Ohio; William R. Arrowsmith, George Porter, Donald M. Samples, Ochsner Clinic, New Orleans, Louisiana; Lois W. Dow, Charles L. Neely, University of Tennessee School of Medicine, Memphis, Tennessee; G. O. Broun, Jr., St. Louis University School of Medicine, St. Louis, Missouri     

Twinning in a colony of vervet monkeys (Cercopithecus aethiops sabaeus)

From 1975 through 1991, three sets of twins were born from a total of 693 live and stillborn births (0.43%) at the UCLA/Sepulveda Veterans Administration Medical Center Nonhuman Primate Research Laboratory, CA. None of the twin's mothers were related. Positive patrilineal relationships have not been established; however, a brother (not a twin) of the first set of twins may have fathered the third set. All twins were born to multiparous females and, in each case, only one infant survived beyond 4 days. One set of twins was dizygotic; the genetic status of the others is unknown. © 1994 Wiley-Liss, Inc.     

Long term depleted uranium exposure in Gulf War I veterans does not cause elevated numbers of micronuclei in peripheral blood lymphocytes

Depleted uranium (DU) is a high density heavy metal that has been used in military munitions since the 1991 Gulf War. DU is weakly radioactive and chemically toxic. Long term exposure can cause adverse health effects. This study assessed genotoxic effects in DU exposed Gulf War I veterans as a function of uranium (U) body burden. Levels of urine U were used to categorize the cohort into low and high exposure groups. Exposure to DU occurred during friendly fire incidents in 1991 involving DU munitions resulting in inhalation and ingestion exposure to small particles of DU and soft tissue DU fragments from traumatic injuries. All of these Veterans are enrolled in a long term health surveillance program at the Baltimore Veterans Administration Medical Center. Blood was drawn from 35 exposed male veterans aged 36-59 years, then cultured and evaluated for micronuclei (MN) using the cytokinesis block method. The participants were divided into two exposure groups, low and high, based on their mean urine uranium (uU) concentrations. Poisson regression analyses with mean urine U concentrations, current smoking, X-rays in the past year and donor age as dependent variables revealed no significant relationships with MN frequencies. Our results indicate that on-going systemic exposure to DU occurring in Gulf War I Veterans with DU embedded fragments does not induce significant increases in MN in peripheral blood lymphocytes compared to MN frequencies in Veterans with normal U body burdens.     

利用长距离PCR扩增国内肠道病毒流行株基因组方法的建立和评价

目的:通过调查近年来我国肠道病毒EV-71型和柯萨奇病毒A16型流行株的全基因组序列,建立一种能够获得我国肠道病毒序列的通用扩增方法,为今后的手足口病流行病学分析、致病机理研究等打下基础。方法:收集我国近5年各地报道的肠道病毒流行株全基因组序列作为参考序列进行比对分析,在保守区设计通用引物,利用3'RACE、长距离PCR扩增及简并引物扩增肠道病毒全基因组序列,采用IonTorrentPGM二代测序仪对扩增产物进行深度测序,以对扩增方法进行验证和评价。结果:通过比对肠道病毒流行株序列设计了通用扩增引物,经二代测序实验获得了肠道病毒全基因组序列;以系列比例模拟混合病毒感染,该扩增方法能够同时获得2株肠道病毒的全基因组序列;能够完整地揭示肠道病毒重组情况。结论:建立了针对我国近年来肠道病毒流行株的通用全基因组扩增方法,在病毒培养液中肠道病毒的提取与扩增中显示了较高的灵敏度,能够反映混合病毒感染、重组病毒的情况。     

Inhibition of Histoplasma capsulatum and Blastomyces dermatitidis by Pseudomonas aeruginosa in vitro

Summary It was accidentally discovered thatPseudomonas aeruginosa inhibited the growth ofHistoplasma capsulatum when both of the organisms were isolated from a series of sputum specimens obtained from a single patient. Experiments were performed to determine if there is any inhibitory effect on other systemic fungi.Three fractions were obtained from a broth culture ofP. aeruginosa and their antibiotic effects tested against various systemic fungi and bacteria.Reviewed in the Veterans Administration and published with the approval of the Chief Medical Director. The statements and conclusions published by the author are the results of his own study and do not necessarily reflect the opinion of the Veterans Administration.     

Epidemiology of No-Code Orders in an Academic Hospital

Relatively little is known about the circumstances in which decisions not to resuscitate, documented by no-code orders, are made. By review of medical records and interviews with house staff officers, we studied all medical service patients for whom no-code orders were written and those patients who received cardiopulmonary resuscitation (CPR) between October and December 1980 in the Portland Veterans Administration Medical Center.Among 1,780 patients admitted, 56 (3.1%) received no-code orders. All decisions were reportedly made by groups of individuals usually including the intern (98% of cases) and resident (93%), but not attending physician (39%). Many patients (43%) were disoriented or obtunded at the time of the no-code decision and 80% of oriented patients did participate in the decision.Thirty-seven of the 56 no-code patients died during the study. Comparing these with 20 patients who experienced cardiac arrest and did receive CPR, cancer, dementia, incontinence, non-ambulatory, divorced-separated and unemployed statuses were all more prevalent among no-code patients (P<.05).No-code orders in this Veterans Administration teaching hospital were relatively common and appeared to be made collectively. Participation of patients and attending physicians in the decisions, however, was limited.