Marvin A. Lavenhar

EFFECT OF TOTAL LYMPHOID IRRADIATION IN CHRONIC PROGRESSIVE MULTIPLE SCLEROSIS

Total lymphoid irradiation (TLI; 1980 cGy) or sham irradiation was given to 40 patients with chronic progressive multiple sclerosis (MS) in a prospective, randomised, double-blind study. During mean follow-up of 21 months, MS patients treated with TLI had less functional decline than sham-irradiated MS patients (p less than 0.01). A significant relation was noted between absolute blood lymphocyte counts in the first year after TLI and subsequent course, patients with higher lymphocyte counts generally having a worse prognosis (p less than 0.01). TLI was well tolerated and associated with only mild short-term, and to date, long-term side-effects.

Assessment of Treatment Outcomes in a Drug Abuse Rehabilitation Network: Newark, New Jersey

A comparative evaluation outcome model designed to aid in referral of clients to appropriate drug abuse treatment centers was developed for a multimodality drug abuse rehabilitation network in Newark, New Jersey. The model analyzes retention rates and treatment dropout outcome to assess impact, and graduate outcome to assess the effectiveness of the various drug abuse treatment centers. Study of 3,943 addicts found a number of demographic and psychosocial variables that correlated with retention in specific programs; retention of some subgroups in specific treatments was substantially longer than overall retention rates. One year retention rates of 65% in methadone maintenance; 22, 16, and 8.5% in the three therapeutic communities; and less than 5% in two outpatient drug-free programs suggested a study of treatment dropouts outcome. Significant reduction in criminality and drug use were found for all treatment dropouts including a “no-treatment” comparison group; however, significantly larger improvements...

The relationship of imaging techniques to the accuracy of frameless stereotaxy.

Objective: We analyzed the accuracy of a frameless stereotactic system using computed tomographic (CT) and magnetic resonance imaging (MRI) scans of different slice thickness and T1 versus T2 weighting of MRI. Methods: An open skull with graphite pegs fixed to its base was used for all scans. CT scans were done with slice thicknesses of 1, 2 and 3 mm. MRI-visible markers were placed on top of pegs for T1-weighted and T2-weighted MRI scans, which were acquired at thicknesses of 1.5, 3 and 5 mm. For each scan, 3 separate registrations of a probe were performed; the distance between the actual probe location and that displayed on the registered image was noted. Each measurements was repeated 3 times for each registration. Results: Greatest accuracy was achieved with 3-mm-slice CT scans; this was not improved by using thinner slices. T1-weighted 1.5-mm MRI scans were 23% less accurate and T2-weighted 3-mm scans 37% less accurate. Conclusions: Frameless stereotaxy should be done using CT scans when the greatest possible accuracy is desired. There appears to be no advantage to using slice thicknesses less than 3 mm. For most craniotomy applications, T1-weighted MRI using 3-mm slices provides sufficient accuracy. Lesions imaged only on T2-weighted MRI also can be approached with adequate precision using 3-mm scans.

Primary and secondary prevention among adults: An analysis with comments on screening and health education☆

A review of the literature relating to a variety of diseases afflicting adults shows that only a small number is preventable by risk factor modification, and in the majority, the risk factors are the societal intoxicants alcohol and tobacco. There is also only a small number of diseases in which there is clear evidence that detection in the early presymptomatic stages results in an outcome different from that observed if the disease is detected when symptoms occur. If primary (risk factor modification) or secondary (early intervention) approaches to medicine are to be effective, health education efforts will have to be augmented markedly. An analysis of health knowledge and patterns of licit and illicit intoxicant use in four schools or school systems suggests that current health education programs are not achieving their stated objectives. A review of current screening practices for asymptomatic persons suggests that the battery of tests used might be significantly altered in order to focus efforts on those diseases that present data show reasonably convincingly can be modified by secondary prevention. A 10-point program of selective screening and risk factor modification is proposed which is believed to be achievable, practical, and acceptable to consumers.

The effect of maternal age, parity, fetal sex and season upon early intrauterine development.

This report presents the results of a computer analysis of 1672 specimens of embryonic material which were obtained by induced abortion in normal pregnancies. The study was undertaken to evaluate the effect of maternal age, parity, fetal sex and seasonal variations on the growth rate of embryos and fetuses which were between six and 20 weeks gestation. Two parameters of intrauterine growth were analyzed: (a) the relation between menstrual age and crown‐to‐rump length and (b) the crown‐to‐rump length versus the body weight ratio. None of the quoted factors seemed to affect the linear growth of the embryo or fetus. The correlations between fetal crown‐to‐rump length and body weight were not influenced by maternal age, parity or fetal sex. Significant (p < 0.001) differences in early intrauterine growth rates were detected in relation to the season of conception. The rate of increase of body weight was far above average in those embryos and fetuses conceived during the summer months, while the opposite was the case when the conception occurred in the fall. An increase in the rate of the weight gain was demonstrated among the products of conceptions which occurred in the winter. There were insufficient data about those fetuses that resulted from conceptions which occurred in the spring.

Recent trends in nonmedical use of drugs reported by students in two suburban New Jersey communities.

Abstract Recent findings in follow-up studies of student nonmedical drug use have indicated that adolescent drug use in the United States is likely to be leveling off. This paper reports trends in student drug use measured by means of repeat surveys conducted in two suburban communities in New Jersey, and compares these trends with those observed in other diverse school populations. Patterns of utilization of specific drugs and categories of drugs are examined, for each sex and school class, using three measurement criteria—experimentation, involvement, and multiple drug use. The New Jersey survey findings are in general agreement with repeat surveys conducted elsewhere. Although teenage experimentation with one or more of a wide variety of illegal substances continues to increase, it appears that, with the possible exception of marijuana, young people are not becoming more committed to the regular use of these substances. However, the New Jersey studies revealed marked age—sex differences in the patterns of usage not only between nearby communities but also within the same community, suggesting that local conditions within a community may have an important effect upon male—female drug use patterns. Some implications of the survey findings for community drug abuse prevention programs are discussed.

Treatment benefit functions for a drug abuse rehabilitation treatment system

While generally justifying the large amount of money invested in the treatment effort, evaluation studies of treatment centers for drug addiction do not offer a rational method of allocating scarce resources among the various available treatment programs. The problem is further confounded by different costs associated with the different programs and also because clients rarely complete the prescribed treatment. We developed functional relationships between treatment outcomes and time in treatment that allow the inclusion of probable length of stay of patients and cost per week for a particular treatment program in the evaluation considerations. The model evolved from a drug addiction treatment system operating in Newark, New Jersey consisting of six different treatment centres. Treatment outcome measures are derived from a psychosocial questionnaire which was administered to patients at appropriate time intervals. The questionnaire probed into the important facets of human behavior as related to the use or non-use of drugs for non-medical reasons. Gompertz curves reflecting treatment benefit are computed for each treatment center by least square fit of the collected data to appropriate differential equations and used together with cost of treatment and treatment retention rates to compute expected net benefit for each treatment center. These enable the researcher to find the treatment centers with the best treatment outcome or alternately with the best expected cost benefit ratio for any patient type.

Modification of an experimental mouse Candida infection by human dialyzable leukocyte extract

Human dialyzable leukocyte extract (10(7) - 10(8) leukocyte equivalents, containing transfer factor) was administered intraperitoneally to CFW mice the day of and 2 days after intravenous infection with Candida albicans. Tissue Candida populations were determined immediately after and 2, 4, 7 and 14 days after infection. Kidney populations were significantly reduced on 27% of the days studied. Similar reduction in C. albicans census was obtained after injection of leukocyte extracts from donors skin test-positive to Candida antigens or donors negative to Candida antigens by skin test and migration inhibition analyses. There was no evidence of a dose-response relationship for leukocyte extract in the range 10(5) - 10(9) leukocyte equivalents. When mice were primed with C. albicans antigen 4 weeks prior to challenge the efficacy of leukocyte extracts was not augmented. There was no evidence that the infection-reducing effects were related to augmented polymorphonuclear leukocyte mobilization, increased mononuclear clearance of C. albicans, or to a direct toxic effect on C. albicans blastospores. These studies suggest that the reduction in Candida populations was non-specific and give further impetus to the use of the dialyzable leukocyte extracts as non-specific supplements to antibiotics in overwhelming or recalcitrant infections in man.

Methodological Problems in Evaluating Drug Misuse Intervention Programmes

In response to the problem of widespread illicit drug use in the late 1960’s, numerous intervention programmes were instituted in the absence of careful planning and tested hypotheses. A great amount of resources in time, energy, and money has been expended in preventive efforts. As the costs of these programmes have spiraled upward, with few apparent successes, the trend has been toward critical assessment of the efficacy of these efforts.