Prevalence of sexual assault among women patients seen in family practice clinics

OBJECTIVE

This study assesses the prevalence and characteristics of sexual assault among women patients attending two family medicine residency training clinics.

METHODS

Two hundred four consecutive women patients 18 years and older were asked to complete a questionnaire; one hundred eighty-eight (92.2%) agreed.

RESULTS

Fifty-four (28.7%) of the 188 women patients reported some type of sexual assault. Approximately 15% of patients reported being victims of rape; 8% reported attempted rape, and 5.3% reported forced sexual contact. Twelve (41.4%) of the 29 rape victims indicated that they had been raped more than once. Only 24% of rape and attempted rape victims reported the incident to police, 18.2% sought medical attention, and 21% sought counseling.

CONCLUSIONS

Family physicians should be aware of the prevalence of sexual assault in their practices and should understand proper questioning, management, counseling, and referral of patients.

An abnormal umbilical artery waveform: a strong and independent predictor of adverse perinatal outcome in patients with preeclampsia

OBJECTIVE

An abnormal umbilical artery Doppler waveform is a risk factor for adverse perinatal outcome. However, it has not been established whether this is related to the earlier gestational age at delivery of fetuses with abnormal Doppler findings or whether Doppler findings are an independent predictor of perinatal outcome. Our purpose was to determine whether an abnormal Doppler umbilical artery waveform is associated with adverse perinatal outcome even after the gestational age at delivery is controlled for as a confounding variable in patients with preeclampsia.

STUDY DESIGN

Umbilical artery velocimetry studies were performed within 7 days of delivery in 72 consecutive patients admitted to our unit with preeclampsia. Adverse perinatal outcome was defined as fetal distress requiring cesarean delivery. Apgar score < 7 at 5 minutes, significant neonatal morbidity, or perinatal death. Significant neonatal morbidity was defined as neonatal sepsis, intraventricular hemorrhage (grade > or = 2), respiratory distress syndrome, pneumonia, bronchopulmonary dysplasia, acute renal failure, or necrotizing enterocolitis. Stepwise multiple logistic regression and receiver-operator characteristic curve analysis were used.

RESULTS

Patients with abnormal umbilical artery velocimetry had a significantly higher rate of complications, including cesarean section for fetal distress, preterm delivery, low Apgar scores, significant neonatal morbidity, and perinatal death, than did patients with a normal waveform. Receiver-operator characteristic curve and stepwise logistic regression analysis indicated that an abnormal umbilical artery waveform was a significant independent predictor for the development of adverse perinatal outcome (odds ratio 14.2, p < 0.005) after other confounding variables were adjusted.

CONCLUSION

An abnormal Doppler umbilical artery waveform is a strong and independent predictor of adverse perinatal outcome in patients with preeclampsia.

Changes in immunoglobulin levels in zinc-deficient mice infected with Trypanosoma musculi

A metabolic imbalance technique was used to study the effects of zinc deficiency on immunoglobulin levels in mice infected with Trypanosoma musculi or immunized with parasite products. Zinc-deficient mice developed higher numbers of parasitemia earlier and exhibited prolonged infection. Irrespective of the diet, higher IgG1, IgG2b, and IgM levels, lower IgG2a and IgA levels, and uniform IgG3 levels were exhibited primarily by mice infected with T musculi and to a lesser extent by mice immunized with parasite products. Zinc-deficient mice showed smaller increases in IgG1 and IgM, but larger gains in IgG2b compared with mice on full-complement and pair-fed diets. However, IgG2a decreased significantly in zinc-deficient mice.

Direct repeat sequences are not required at the breakpoints of age-associated mitochondrial DNA deletions in rhesus monkeys

The large majority of mitochondrial DNA (mtDNA) deletions analyzed from mitochondrial myopathies and aging humans have been found to be flanked by direct repeats, a finding which has led to the slip-replication hypothesis of deletion formation. In this study, we have characterized 13 mtDNA deletion breakpoints from skeletal muscle harvested from 9- to 27-year-old rhesus monkeys. Seven of the deletions, five of which were unique to a particular animal, did not have direct repeats at the deletion breakpoints. In contrast, two of the three deletions common to several animals had direct repeats flanking the breakpoints. It appears, therefore, that at least two different mechanisms exist by which mtDNA deletions are formed during aging, one requiring and one independent of flanking direct repeats. Furthermore, the species in which mtDNA deletions are detected may determine which mechanism predominates.

Role of Helicobacter pylori in cirrhotic patients with peptic ulcer. A serological study

Helicobacter pylori was found to be a promoter factor of peptic ulcer that has an incidence higher in patients with hepatic cirrhosis. To clarify the role between H. pylori and peptic ulcer in patients with hepatic cirrhosis, a serological test (ELISA test, HEL-p, AMRAD, Australia), was used to measure the presence of H. pylori of patients with hepatic cirrhosis. Within two years, 108 cirrhotic patients who had received a panendoscopic examination were enrolled in this study. There were 79 males and 27 females with a mean age of 53.2 years. Sixty-four cases had positive serum HBsAg and 44 had negative serum. The results showed that the prevalence of Helicobacter pylori in cirrhosis was 43.5% (47/108). There was no difference of HEL-p-positive rate between peptic ulcer and normal gastroduodenal mucosa (45.2% vs 46.1%, P > 0.05). According to this study, there appears to be no relation between peptic ulcer and H. pylori in patients with hepatic cirrhosis. The etiology of peptic ulcer in cirrhotic patients need further study.

Complement C1q does not bind monomeric beta-amyloid

The tendency of both labeled and unlabeled beta-amyloid to bind in solution to C1q, the recognition species in the complement cascade, was examined using both hydrodynamic and spectroscopic methods. Potential binding interactions were evaluated using a purified synthetic beta-amyloid 1-40 sequence, alone, and selectively labeled at the amino terminus with spectroscopic probes. The probes permitted both absorbance and fluorescence analyses of beta-amyloid binding interactions. Under conditions used for the analyses beta-amyloid exists exclusively as a monomer in solution, and C1q retains an intact quaternary structure and is capable of binding to IgM. When mixed together the monomeric beta-amyloid does not bind to, or interact with, the complement C1q at concentrations below approximately 100 microM. The data suggest that if beta-amyloid toxicity is associated with complement activation in Alzheimer's disease then monomeric beta-amyloid is likely not responsible for activation through the classical complement pathway.

The regulation of membrane 125I- and 86Rb+ permeability in a virally transformed cell line (NCL-SG3) derived from the human sweat gland epithelium

We have explored the factors that may regulate membrane permeability in a cell line (NCL-SG3) derived from the human sweat gland epithelium. Ionomycin increased the rate of 125I-efflux from preloaded cells and this action appeared to be due to an increase in intracellular free calcium ([Ca2+]i). The ionomycin-evoked increase in 125I- efflux was reduced in cells that were exposed either to barium or to valinomycin in the presence of a high concentration of external potassium. It thus appears that a fraction of the ionomycin-evoked increase in 125I- efflux is due to the activation of potassium channels and experiments using 86Rb+ also suggested that ionomycin increased the rate of potassium efflux, an effect which was totally abolished by barium. Blockade of Na(+)-K(+)-2Cl- cotransport and of Cl- -HCO3- exchange reduced the basal rate of 125I- efflux and the ionomycin-evoked increase in 125I-efflux from control cells and from cells depolarized by valinomycin. These transport systems thus contribute to anion efflux, although [Ca2+]i-dependent chloride channels also appear to be present. Acetylcholine increases [Ca2+]i in the secretory cells of human sweat glands, but this neurotransmitter did not increase [Ca2+]i in NCL-SG3 cells and so membrane permeability was not under cholinergic control. Adrenaline did not increase [Ca2+]i, but this hormone did evoke cyclic-3',5'-adenosine monophosphate (cyclic AMP) production. However, membrane permeability was not under adrenergic control, as the cells did not appear to express functional, cyclic AMP-dependent anion channels. This may be because they were not fully differentiated under the culture conditions. ATP consistently evoked a dose-dependent increase in anion efflux that appeared to be mediated by [Ca2+]i. The increase in [Ca2+]i was initiated by the release of calcium from a limited internal store and was subsequently sustained by calcium influx. UTP and ADP also increased [Ca2+]i, whereas adenosine, AMP and alpha,beta-methylene ATP were without effect. These data thus suggest that a subclass of type 2 purine receptor, which is functionally coupled to phosphoinositidase C, is present in these cells.

Fish oil supplementation attenuates free radical generation in short-term coronary occlusion-reperfusion in cholesterol-fed rabbits

We studied the changes in lipid peroxidation and prostanoid metabolism in short-term coronary occlusion-reperfusion in controls and those rabbits (11 in each group) fed a 1% high cholesterol diet with or without 10% fish oil supplementation for one week. Acute coronary occlusion for 10 minutes was induced by ligating the marginal branch of the left circumflex coronary artery. The vessels were then reperfused for 1 hour. The cholesterol and fish oil treated rabbits had the lowest malondialdehyde levels both in the ischemic and non-ischemic (normal) areas, the least increase of malondialdehyde level in the ischemic area, and the highest 6-keto-PGF1 alpha/thromboxane B2 ratio in the non-ischemic area after reperfusion among the 3 groups. These rabbits had the highest myocardial superoxide dismutase levels both in the ischemic and normal areas, and the least decrease of superoxide dismutase level in the ischemic area. These data suggest that rabbits fed a high cholesterol diet with fish oil supplementation had an attenuated lipid peroxidation, which reflected a reduced free radical generation during a short-term coronary occlusion followed by reperfusion.

Hydronephrosis accidentally detected by gastrointestinal sonography

A retrospective study was carried out on patients with gastrointestinal complaints, who were accidentally found to have varying degrees of hydronephrosis between October 1989 and April 1991. The criteria for hydronephrosis given by Ellenbogen et al were used for ultrasonographic diagnosis. Grade 0 and 1 were classified as mild degree and grade 2 and 3 as moderate and severe, respectively. The causes of hydronephrosis were determined by intravenous pyelography, retrograde pyelography, and/or computed tomography. Of 44 patients with hydronephrosis who had complete studies, 20 had a mild degree of hydronephrosis, 18 had a moderate degree, and 6 had a severe degree. All 24 patients with moderate and severe degrees of hydronephrosis had obstruction as the etiology, but only 50% of the cases with mild hydronephrosis were found to have pathological lesions. Urolithiasis (79.4%) was the most common cause of hydronephrosis in this study. Benign prostate hypertrophy, carcinomas, external compression, and tuberculosis followed. Hydronephrosis found accidentally by sonography in the patients with gastrointestinal complaints is significant.

Fiberoptic bronchoscopic Nd-YAG laser therapy in obstructive airway diseases

BACKGROUND

This study reports the results of Neodymium-Yttrium-Aluminum Garnet (Nd-YAG) laser resection on benign and malignant obstructing airway diseases which has been done in our hospital for four years. The effect of this treatment on patients' arterial blood gases, during and after the process is also analyzed. The benefit of adjuvant therapy with radiotherapy and/or chemotherapy after laser vaporization is discussed.

METHODS

Fiberoptic bronchoscopic Nd-YAG laser therapy was performed in 32 cases of lung cancer (primary 27, secondary 5) and 11 cases of benign tracheobronchial diseases with total or near total airway obstruction. The therapy was performed through the oral route under local anesthesia. The result of therapy was classified as "excellent", "fair" or "poor" depending upon the degree of recanalization and clinical improvement. A cannula was inserted into the radial artery in lung cancer patients before the procedure. Samples of blood to determine arterial blood gas levels were drawn before, during and after treatment. After bronchoscopic laser therapy, radiotherapy and/or chemotherapy were given to the patients of lung cancer.

RESULTS

The effective rate (excellent and fair) was 75% in lung cancer and 81.8% in benign airway obstruction. In the lung cancer group, significant decline of PaO2 was noted during and after Nd-YAG laser therapy. Decrease of PaO2 was not recovered even 5 hours after laser vaporization. After bronchoscopic Nd-YAG laser therapy, 21 of 32 lung cancer patients received radiotherapy (at least 3000 rads) and/or chemotherapy (at least 3 times). The median survival time was 5.5 months. The other 11 patients received laser therapy only, with median survival time was 2.9 months (p < 0.05).

CONCLUSIONS

Endobronchial Nd-YAG laser therapy of obstructing lesions has been proved to be effective and relatively safe in well-trained hands. Oxygen supplementation was suggested in patients with hypoxemia before laser therapy. After endobronchial Nd-YAG laser therapy, better survival and life quality result if radiotherapy and/or chemotherapy are added for the lung cancer group.

Multiple mitochondrial DNA deletions associated with age in skeletal muscle of rhesus monkeys

We have examined skeletal muscle for the presence of age-associated mitochondrial DNA (mtDNA) deletions from 16 rhesus monkeys (age range 6-27 years). All animals over 13 years of age contained potential mtDNA deletions, whereas the presence of deletions was greatly reduced or absent in younger animals. The specific deletion patterns varied from individual to individual. Numerous mtDNA deletions accumulate with age in skeletal muscle from a nonhuman primate, indicating that the rhesus monkey may provide an excellent animal model to study mtDNA deletions. Further, the existence of multiple mtDNA deletions supports the possibility that they may contribute to geriatric muscular deficits, which are nearly universal in occurrence yet poorly understood.

Microbial reduction of sulfur dioxide with pretreated sewage sludge and elemental hydrogen as electron donors

It has been demonstrated tht heat- and alkali-pretreated-sewage sludge may serve as an electron donor and carbon source for SO2 reduction by Desulfovibrio desulfuricans. A continuous D. desulfuricans culture was operated for 6 mo with complete reduction of SO2 to H2S. The culture required only minor amounts of mineral nutrients in addition to pretreated sewage sludge. It has also been shown that the sulfate-reducing bacterium Desulfotomaculum orientis can be grown on H2 as an energy source, CO2 as a carbon source, and SO2 as a terminal electron acceptor. Complete reduction of SO2 to H2S was observed.

Reduction of nitric oxide by denitrifying bacteria

Two heterotrophic denitrifying bacteria, Paracoccus denitrificans and Pseudomonas denitrificans, have been shown to utilize nitric oxide (NO) as a terminal electron acceptor and succinate, yeast extract, and heat/alkali pretreated municipal sewage sludge as carbon and energy sources. Complete removal of NO (0.50%) from a feed gas sparged into the cultures was observed. It is suggested that reduction of NO may be a common feature of denitrifying bacteria and that a microbial process to dispose of NO(x) may be economically viable.

Case of difficult intubation overcome by the laryngeal mask airway

A case of difficult intubation is described in which the problem was overcome by use of the laryngeal mask airway (LMA). The patient had difficulty in mouth opening due to severe burn scar contracture around the mouth and limited access prevented tracheal intubation. The use of LMA is shown to have obviated the need for tracheal intubation in the case of a patient whose injuries would have made this technique difficult.

Molecular characterization of a conserved, guanine nucleotide-dependent ADP-ribosylation factor in Drosophila melanogaster

ADP-Ribosylation factors (ARFs) are ubiquitous approximately 20-kDa guanine nucleotide-binding proteins that stimulate cholera toxin-catalyzed ADP-ribosylation in vitro. Because the functional role(s) of ARF in mammalian systems is (are) elusive, we looked for ARF in Drosophila melanogaster, and report the partial purification and molecular cloning of an ARF from Drosophila. We cloned the Drosophila ARF 1 gene without library screening by a combination of 5 polymerase chain reactions (PCRs), yielding a 546-base open reading frame encoding 182 amino acids, which are > 93% identical to those of mammalian class I ARFs. This ARF gene maps to 79F3-6 in the proximal region of the left arm of Drosophila chromosome 3. The Drosophila ARF1 gene structure, including placement of introns, is highly conserved relative to mammalian class 1 ARF genes. A single ARF mRNA species of 1.8 kb was abundant in all Drosophila body segments. Recombinant Drosophila ARF 1 synthesized in Escherichia coli had biochemical and immunochemical activities similar to those of mammalian ARF. The similarities of sequence and biochemical properties between Drosophila and mammalian ARFs contrast with their differences from Drosophila arl (ARF-like protein), which does not stimulate cholera toxin-catalyzed ADP-ribosylation, and is only approximately 52-56% identical in amino acid sequence to mammalian ARFs.

Calcium antagonistic and antiarrhythmic actions of CPU-23, a substituted tetrahydroisoquinoline

1. The effects of CPU-23 (1-(1-[(6-methoxyl)-naphth-2-yl])-propyl-2-(1-piperidine)-acetyl-6 ,7- dimethyoxy-1,2,3,4-tetra-hydroisoquinoline) were studied on mechanical and electrical activities, and intracellular free calcium ([Ca2+]i) of isolated cardiac tissues in order to investigate its spectrum and mechanisms of action in the heart. Its antiarrhythmic and haemodynamic effects in pentobarbitone-anaesthetized rats subjected to coronary artery ligation were also evaluated. 2. CPU-23 at 10(-6)-10(-4) M markedly inhibited slow action potential characteristics in guinea-pig papillary muscles and pace-maker action potential of rabbit sinoatrial node. It affected fast action potential only at 10(-4) M. None of the effects of CPU-23 was reversed by washout for up to 2 h. 3. Like nifedipine and diltiazem, CPU-23 decreased the heart rate of the isolated perfused heart of the rat. However, in contrast to these two classical calcium antagonists which dose-dependently inhibited the force of contraction, CPU-23 inhibited and stimulated the force of contraction at 10(-7)-3 x 10(-6) M and 10(-5) M, respectively. 4. CPU-23 at 10(-6)-10(-5) M inhibited the KCl-induced [Ca2+]i increase in the Ca2+ medium, but did not affect the caffeine-induced [Ca2+]i increase in the Ca(2+)-free medium in isolated ventricular myocytes. 5. CPU-23 at 1-5 mg kg-1 reduced dose-dependently ventricular arrhythmias including ventricular ectopic beats, VT and VF as well as mortality during coronary artery ligation. At 2.5-5 mg kg-1 it even abolished VF, which was accompanied by 100% survival. 6. It is suggested that CPU-23 has calcium antagonistic properties in cardiac tissues. It selectively blocks the transmembrane influx of extracellular Ca2+ through Ca2+ channels, thus reducing the heart rate and developed tension, altering the slow action potential characteristics and producing antiarrhythmic effect against ischaemic arrhythmias.

Clinical norms for amplitude of accommodation in Chinese

Amplitude of accommodation was measured in 121 Hong Kong Chinese subjects between the ages of 11 and 65 years, using the 'push-up' method and the results compared with those previously obtained for Caucasian subjects. The results confirm and quantify clinical experience that Chinese people have lower amplitudes of accommodation than Caucasians. If presbyopia is considered to commence when the amplitude of accommodation declines to less than 5 D, then presbyopia in the Chinese race occurs between the ages of 36 and 40 years. By early in the second decade of life the amplitude of accommodation in the Chinese is already lower than that of Caucasians. This suggests that reduced amplitude of accommodation may be due, at least in part, to factors other than longterm environmental effects.

Hip fracture incidence in Malaysia 1981-1989

The age-corrected incidence of hip fracture in the city of Kuala Lumpur and the surrounding districts has increased from 1981 to 0.7 per 1,000 population in 1989. Women dominated by a factor of 1.3. The mean age was 73 (50-103) years. The increased rate observed was attributed solely to trochanteric fractures among those 70 years and above. There were differences in the various parameters among the different races. The fracture incidence and woman/man ratio were substantially lower than has been reported from developed countries.

The management of complicated hepatolithiasis with intrahepatic biliary stricture by the combination of T-tube tract dilation and endoscopic electrohydraulic lithotripsy

Hepatolithiasis with intrahepatic biliary strictures, more common in Southeast Asia than elsewhere, remains a difficult problem to manage. Retention of stones behind strictures after surgery is a frequent and troublesome complication. Post-operative duct dilation with percutaneous transhepatic cholangioscopy tube stenting through a matured T-tube tract was performed in 15 patients. Choledochoscopic electrohydraulic lithotripsy was applied in six patients when impacted or large stones were encountered. Complete clearance of stones was achieved in 12 patients (80%). Two patients had fevers develop after ductal dilation and recovered after conservative treatment. These 12 successfully treated patients remain well, with a mean follow-up of 18 months. Post-operative T-tube tract dilation, selectively combined with endoscopic electrohydraulic lithotripsy, is an effective and safe method for complicated hepatolithiasis with biliary strictures.

Conformational study of two substance P hexapeptides by two-dimensional NMR

The conformation of two substance P (SP) related hexapeptides. Glp-Phe-Phe-(L-Pro)-Leu-Met.NH2 (I) and Glp-Phe-Phe-(D-Pro)-Leu-Met.NH2 (II), in two solvents, chloroform-d and trifluoroethanol(TFE)-d3/H2O, was studied by two-dimensional NMR methods, including COSY, TOCSY, ROESY and HMQC. The study shows that these two peptides exist predominantly in the extended form in TFE/H2O, but in general exhibit a reverse-turn structure in chloroform. I is clearly less ordered than II in both solvents. Furthermore, extensive Phe3-Pro4 cis<==>trans isomerization was found in I but not in II. The differences in the conformational behavior of these two peptides, which are selective agonists for neurokinin NK1 and NK2 receptors, respectively, are discussed.

Eosinophilic gastroenteritis: 10 years experience

Eight patients (five men, three women), mean age 36.9 +/- 13.5 (17-60) yr, were diagnosed to have eosinophilic gastroenteritis. The condition was proved in five patients by biopsies through endoscope, and in three, by operation. All had hypereosinophilia (absolute eosinophil count of 1,337-21,787/cm3). According to Klein classification, two had mucosal disease, three had muscle layer disease, and three, subserosal disease. The most common symptoms were abdominal pain (100%), diarrhea (62.5%), vomiting (62.5%), and nausea (50%). Four patients (50%) had symptoms for more than 1 yr before diagnosis. Barium studies revealed mucosal edema and/or thickening of the small intestinal wall in three cases (including one case with ulceration), partial gastric outlet obstruction in one case, and narrowing of lumen of the terminal ileum in one case. Hypotonic duodenogram revealed double contour in one case. Ultrasound examination revealed thickening of the intestinal wall in two cases; computer tomography revealed thickening of the intestinal wall in one case. All patients were treated with steroid (40 mg/day for initial dose and relapse; 5-10 mg/day for maintenance). The symptoms subsided and the eosinophil counts returned to normal within 2 wk in seven patients and 1 month in one. Of six patients being followed up for 2-10 yr, one had remission, four needed small maintenance dose of steroid, and one suffered from relapse with intestinal perforation.

Lithospermic acid B as an antioxidant-based protector of cultured ventricular myocytes and aortic endothelial cells of rabbits

Lithospermic acid B, an active principle found in a Chinese herbal medicine for treating various heart ailments, was recently isolated, purified and demonstrated by us to salvage the postischemic rabbit heart from reperfusion injury. In this work, we further report that lithospermate B is able to protect each of two types of rabbit cardiocytes, namely ventricular myocytes and aortic endothelial cells against necrosis inflicted by oxyradicals generated pharmacologically with xanthine oxidase and hypoxanthine. Biochemically, the lithospermate B also inhibits the reduction of cytochrome c by superoxide radical anion. Thus, our in vitro data here are in concord with our earlier in vivo finding that lithospermic acid B is most likely an effective antioxidant-based myocardial protector.

Demonstration of the myocardial salvage effect of lithospermic acid B isolated from the aqueous extract of Salvia miltiorrhiza

Lithospermic acid B has been isolated to > 95% purity by high performance liquid chromatography from the aqueous extract of the roots of Salvia miltiorrhiza. When infused at 5.5 mumoles/kg into the post-ischemic rabbit heart, it reduced by 62 +/- 10% (n = 8) the myocardial damage found in the saline control in a rabbit ischemia-reperfusion model.

Sequential invasions of pancreatic pseudocysts in pancreatic tail, hepatic left lobe, caudate lobe, and spleen

A 66-year-old male patient without a history of risk factors for pancreatitis suffered from pancreatitis and developed pseudocyst. During the course of treatment and follow-up, the pseudocyst was found to have migrated through the pancreatic tail, left hepatic lobe, caudate lobe, and spleen on abdominal sonography and computed tomography scan. Finally, emergent laparotomy was done for splenic abscess and removal of infected pseudocyst in the spleen and lesser sac of the abdomen. The patient made a full recovery after operation.