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In drawing entirely different conclusions from the same bank of data, Conroy saw consistent evidence favoring the alternative CLAs over the small ICFs in Pennsylvania while Crinella et al. found a large regression artifact produced by matching the ICF and CLA residents on adaptive behavior scores. Ten areas of flawed logic, analysis, and interpretation have undermined both sides of the argument. Conroy's matching--which might not have been necessary in the first place--does not pose a serious threat of regression artifacts. Because of two subtle but fatal errors, the Monte Carlo experiment of Crinella et al. provides no important evidence against Conroy's findings. Other problems, however, require a small reduction in his pro-CLA results, along with a substantial limit on their generalizability.

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The penetration of oral cefixime into the synovial fluids of 16 patients (mean age, 50.6 years) who underwent joint taps for rheumatic noninfectious disorders was examined. The patients were each given a single dose (400 mg) 2 to 24 h prior to the tap. Cefixime concentrations in serum and joint fluid samples were measured by high-performance liquid chromatography, and the bactericidal activities of these fluids against three isolates each of Haemophilus influenzae and Escherichia coli were examined. The highest concentrations in serum and synovial fluid were achieved 4 h following drug intake, the mean values being 2.8 and 2.03 micrograms/ml, respectively. Effective bactericidal activities (bactericidal titer, > 1:2) against E. coli and H. influenzae were demonstrated in serum and joint fluid up to 10 h following oral intake of cefixime. These results suggest that cefixime penetrates well into joint fluid, achieving levels above the MIC for E. coli lasting as long as 10 h and levels above the MIC for H. influenzae lasting up to 24 h after administration. Good bactericidal activity against susceptible bacterial isolates was observed for at least 10 h after dosing.

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UNLABELLED: We performed this study in an attempt to reconcile the differences with respect to 67Ga uptake as a function of tumor grade and type in the literature, as well as to determine the sensitivity of 201Tl uptake in both Hodgkin's and non-Hodgkin's lymphoma. METHODS: Thirty-six (9 with low-grade lymphoma, 11 with intermediate-grade lymphoma, 4 with high-grade lymphoma and 12 with Hodgkin's lymphoma) patients underwent both 67Ga and 201Tl scintigraphy. Biopsies were done on all patients. A semiquantitative rating system was used to make statistical comparisons for thallium versus gallium in all lymphoma subgroups, as well as comparisons of thallium and gallium to themselves in all subgroups. RESULTS: Patient sensitivity was only 56% and site sensitivity was 32% in patients with low-grade lymphoma. Conversely, 201Tl sensitivity was 100%, respectively, for patients and sites. The difference between 201Tl and 67Ga sensitivity in patients with low-grade lymphoma on a site basis was statistically significant. When compared to itself in lymphoma subgroups, 201Tl was found to be statistically more avid for low-grade lymphoma than for intermediate, high or Hodgkin's lymphoma. Gallium-67 sensitivity for low-grade lymphoma was significantly less than for Hodgkin's and intermediate grade lymphomas. No significant differences were found when 201Tl and 67Ga were compared in the intermediate, high or Hodgkin's lymphoma groups. CONCLUSION: Thallium-201 demonstrates significantly greater tumor avidity in the low-grade lymphoma group compared to 67Ga citrate. Gallium-67-citrate appears relatively nonavid for low-grade lymphoma compared to 201Tl and is statistically inferior in detecting low-grade lymphoma in comparison to its ability to detect intermediate or high-grade lymphomas. Gallium-67-citrate should not be considered dependable in evaluating patients with low-grade lymphoma. Neither 201Tl or 67Ga is dependable in the evaluation of low-grade lymphoma within the abdomen, since gallium avidity for low-grade lymphoma is low and gastrointestinal excretion of 201Tl is poorly controlled.

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Cystadenocarcinoma of the pancreas is generally considered to be unresponsive to chemotherapy and radiation therapy. We present two cases of laparotomy-proven unresectable cystadenocarcinoma which responded to intravenous 5-fluorouracil (1,000 mg/m2/24 hr x 5 days x 2) and 4,000 rads of radiation therapy. Both patients had objective response with marked shrinkage of the tumor as determined by clinical examination and computed tomography. At reexploration both tumors had become completely resectable with histologically clear margins and negative lymph nodes. Carcinoembryonic antigen (CEA) levels were elevated in both patients at initial presentation (86 and 71 ng/ml). The CEA levels declined to 19.9 and 66.0 ng/ml, respectively, after neo-adjuvant therapy, and both fell to normal levels after resection. Although surgical resection has been considered the only curative therapy for patients with pancreatic cystadenocarcinoma, we suggest that preoperative irradiation and chemotherapy may reduce the size of seemingly unresectable tumors. We also recommend serial CEA determinations in patients with levels initially elevated as a marker of the response to neo-adjuvant and operative therapy.

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Potential sources of stress and satisfaction as perceived by direct-care staff members in community residences for mentally retarded adults were investigated. Results indicated that stress and satisfaction are not polar opposites but two largely separate dimensions of workers' experiences. In addition, sources of satisfaction and stress had two components, resident-related and work-related. Analysis of 15 background characteristics yielded few significant relationships with workers' levels of stress or satisfaction.

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Immunologic studies demonstrate that non-Hodgkin's lymphomas are derived predominantly from B- or T-lymphoid cells, while node-based tumors of true histiocytic derivation are rare, with few documented cases. This report describes the clinical, histologic, immunohistochemical, and ultrastructural features of two cases of node-based true histiocytic lymphoma. Distinctive ultrastructural features included numerous cytoplasmic lysosomes, surface microvillous processes, and occasional cell junctions, and the cells stained strongly for alpha-napthyl acetate esterase and alpha one-antitrypsin. Since there are few specific histologic features, special technics may be essential in confirming the diagnosis of true histiocytic lymphoma, and determining appropriate therapy.

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The effect of epilepsy and anti-epileptic treatment on neonatal outcome was investigated in 86 pregnancies terminating in delivery. Various maternal and neonatal parameters were considered. Each infant born to an epileptic mother was double-matched with two infants born to healthy mothers and the results were submitted for statistical analysis. Infants of epileptic mothers had smaller head circumference. Primidone was the only anti-epileptic drug, taken during pregnancy, to have a significant effect on infant head circumference. The results suggest that a drug effect, rather than an association with maternal epilepsy, is responsible for this difference. Hypertelorism is the only congenital anomaly to be significantly more frequent in newborns of epileptics. All drugs, except for primidone, were associated significantly with this anomaly. Further similar studies and prolonged follow-up of the infants of epileptic mothers are necessary before drawing any final conclusions regarding the outcome of these infants.

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One hundred and fifteen patients with advanced gastrointestinal cancer (stomach cancer, 42 patients; gastroesophageal junction cancer, ten; pancreatic cancer, 32; and other upper gastrointestinal cancers, 31) were treated with a combination chemotherapy regimen consisting of 5-FU, doxorubicin, mitomycin, and semustine (methyl-CCNU) (FAMMe). Of the 31 patients with stomach cancer who were evaluable for response and had had no previous chemotherapy, 12 (39%) achieved complete or partial remission. One of eight (12%0 patients with gastroesophageal junction cancer and five of 23 (22%) patients with pancreatic cancer achieved a partial remission. The median duration of survival for all patients with adenocarcinoma of the stomach was 7.1 months. The median duration of survival for responding patients with stomach cancer was 13.6 months, and the median survival for nonresponding patients was 6.1 months. FAMMe chemotherapy was generally well-tolerated and can be administered in adequate doses without producing prohibitive myelosuppression. The starting dose should be reduced for patients greater than or equal to 70 years old or for patients who have received pelvic or vertebral radiation therapy. FAMMe is effective against advanced gastric cancer; however, because this was not a randomized comparative study of the relative effectiveness of FAMMe and FAM (5-FU, doxorubicin, and mitomycin), no recommendation for the use of one regimen instead of the other for advanced adenocarcinoma of the stomach can be made. FAMMe chemotherapy cannot recommended for advanced adenocarcinoma of the pancreas and gastroesophageal junction.

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Prediction models for outcome of behavioral parent training were developed. Forty-nine families completed a training program for parents of mentally retarded children and were followed-up 14 months later. The outcome variables were the mother's posttraining knowledge of behavioral principles and follow-through programming. Predictor variables included parents' socioeconomic status, education, pretraining experience, performance during training, and child characteristics. The relationships between predictor and outcome variables were utilized in discriminant analyses to yield prediction formulae. The accuracy of predictions and their clinical implications were discussed.

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The variety of services provided by clergy on behalf of mentally retarded persons and their families was investigated. Rating scales, administered during semi-structured interviews, were used with a diverse sample of 40 pastors to explore: services already provided; willingness to undertake other services; felt competence to provide the services on a comprehensive list; suggestions for dividing the responsibility for each service among parents, clergy, and secular professionals. The data displayed a wide range of services provided by the sample as a whole, revealed substantial individual differences, and showed clear preferences for some areas of service over others. Involvement in a given area was strongly associated with feelings of competence but not feelings of responsibility. Relationships with secular specialists and prospects for enhancing the clergy's involvement were discussed.

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Ninety-five families who had completed a 20-week behavioral-training program for parents of retarded children (Heifetz, 1977) were re-contacted 14 months later. An in-home interview and several questionnaires assessed maintenance of child gains and parents' knowledge of programming principles, as well as the extent and quality of continued and new programming, perceived obstacles to home teaching, and perceived effects of the training program. Parents had retained their knowledge of programming principles, and the children had retained their original skill gains. Many families had initiated some teaching of new skills, although few parents carried out regular formal teaching sessions. Almost one-half of the families were classified as having continued to employ useful or very useful teaching. The main perceived obstacles to home-teaching were limitations in time, in the child's learning ability, in the parent's teaching ability, and in professional support. The implications of these follow-up results for future training programs were discussed.

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Ninety patients with Stage I or II, including extranodal (E), presentations of non-Hodkin's lymphoma were investigated by laparotomy, either for the definitive staging of patients with peripheral presentations or for diagnosis of abdominal disease. Sixty-eight patients had staging laparotomies after extensive work-up, which included lymphangiography and bone marrow biopsy. The remaining 22 patients had laparotomies for diagnosis of abdominal symptoms or for management of unrelated surgical problems, with lyphoma being found incidentally. The incidence of positive abdominal findings in the 68 patients who had staging laparotomies depended on histologic subtype. In nodular lymphoma patients, abdominal disease was found in 17 of 28 (61%) and in diffuse lymphoma patients, in 9 of 40 (22.5%). For patients with nodular lymphomas upstaged by laparotomy, the positive findings tended to cluster around an axis consisting of the celiac, porta-hepatic, para-aortic, and root of the mesentery lymph nodes. In addition, 64% of these patients had splenic involvement. For the diffuse lymphoma upstaged by laparotomy, the distribution of positive findings was similar to that of the nodular lymphoma group; however, only 1 patient had splenic involvement. By contrast, in approximately half of the diffuse lymphoma patients who had laparotomies for diagnosis, the gastrointestinal tract was found to be involved in addition to the previously cited lymph nodes.

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A series of instructional manuals in behavior modification with retarded children was tested as a self-contained resource and as part of three larger training programs involving different amounts of professional assistance to parents: telephone consultations, training groups, training groups plus home visits. One hundred and sixty families were randomly assigned to the four training conditions or to a delayed-treatment control group. The 20-week treatment period emphasized the programming of self-help skills, but also provided an introduction to programming language skills and managing behavior problems. The manuals-alone format was as effective as the more expensive training formats in producing gains in children's self-help skills and fostering knowledge of behavioral principles in mothers. The two group-training formats produced more efforts at behavior-problem management, greater gains in knowledge of principles by fathers, and higher self-confidence as teachers. Telephone consultation was generally the least effective training format; the manuals-alone condition was surprisingly effective. Some implications of the results for future strategies of family intervention were discussed.

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