Parent development

Today's parents tend to be overwhelmed with advice from many sources. In his role as family counselor, the pediatrician must understand and consider the emotional development of parents in relation to their child's development; otherwise, his advice and counsel do not "take" and he becomes tired and frustrated and angry. PARENTS PROGRESS THROUGH DEFINITE STAGES OF DEVELOPMENT: Stage 1: Learning the cues-the struggle of the parents to interpret the infant's needs. Stage 2: Learning to accept growth and development-the parent learning to accept some loss of control of the toddler. Stage 3: Learning to separate-the parent learning to allow the child to develop independently. Stage 4: Learning to accept rejection, without deserting-the struggle of the parents not to intrude and yet to be there when needed. Stage 5: Learning to build a new life having been thoroughly discredited by one's teenager-the parent learning to live independently while the teenager struggles to develop his own identity.The pediatrician who is accepting, sensitive and a good listener and who keeps in mind that parents as well as children have capacities for growth and development, will be a potent factor in promoting good parent-child relationships and many times more effective in dealing with the child in health and disease.     

Adrenalectomy for control of cancer of the breast

Bilateral oophorectomy and adrenalectomy were used in the treatment of ten patients with advanced metastatic carcinoma of the breast, and particular attention was given to preoperative and postoperative management by a team of specialists including surgeons, endocrinologist, radiologist and pathologist. Objective and gratifying clinical remissions were achieved in three of the ten patients in this series following total oophorectomy and adrenalectomy. The remaining seven patients all subsequently died of metastatic disease. There were no operative deaths. Known cerebral or hepatic metastasis contraindicates adrenalectomy for metastatic cancer of the breast. Five of the seven patients not benefited by the operation had either cerebral or hepatic metastasis. The best candidates for adrenalectomy are premenopausal women who have previously had a clinical remission following oophorectomy and who have subsequently relapsed. The indications for adrenalectomy in the postmenopausal woman are not clear.     

Plasminogen activator and collagenase production by cultured capillary endothelial cells

Cultured bovine capillary endothelial (BCE) cells produce low levels of collagenolytic activity and significant amounts of the serine protease plasminogen activator (PA). When grown in the presence of nanomolar quantities of the tumor promoter 12-O-tetradecanoyl phorbol-13-acetate (TPA), BCE cells produced 5-15 times more collagenolytic activity and 2-10 times more PA than untreated cells. The enhanced production of these enzymes was dependent on the dose of TPA used, with maximal response at 10(-7) to 10(-8) M. Phorbol didecanoate (PDD), an analog of TPA which is an active tumor promoter, also increased protease production. 4-O-methyl-TPA and 4α-PDD, two analogs of TPA which are inactive as tumor promoters, had no effect on protease production. Increased PA and collagenase activities were detected within 7.5 and 19 h, respectively, after the addition of TPA. The TPA-stimulated BCE cells synthesized a urokinase-type PA and a typical vertebrate collagenase. BCE cells were compared with bovine aortic endothelial (BAE) cells and bovine embryonic skin (BES) fibroblasts with respect to their production of protease in response to TPA. Under normal growth conditions, low levels of collagenolyic activity were detected in the culture fluids from BCE, BAE, and BES cells. BCE cells produced 5-13 times the basal levels of collagenolytic activity in response to TPA, whereas BAE cells and BES fibroblasts showed a minimal response to TPA. Both BCE and BAE cells exhibited relatively high basal levels of PA, the production of which was stimulated approximately threefold by the addition of TPA. The observation that BCE cells and not BAE cells produced high levels of both PA and collagenase activities in response to TPA demonstrates a significant difference between these two types of endothelial cells and suggests that the enhanced detectable activities are a property unique to bovine capillary and microvessel and endothelial cells.