The marriage squeeze and the rise in informal marriage in Brazil

Around the world, populations have experienced shortages of one sex or the other at marriageable ages, as a result of mortality declines. The solutions to this problem vary with the cultural context. Declines in the spousal age difference and increases in dowry payments (India) and polygamy (Africa) are two adjustments to a disequilibrium in the marriage market. We hypothesize that in Brazil the marriage market finds its balance by "recycling" men through highly unstable informal unions. Using census and 1984 survey data, we establish the relationship between a marriage squeeze and the increase in informal marriage. Census data and a competing-risks analysis of marriage choice provide evidence that a marriage squeeze has affected both the chances of marrying at all and the type of marriage entered.

Crystal structure of endo-beta-N-acetylglucosaminidase F1, an alpha/beta-barrel enzyme adapted for a complex substrate

Endo-beta-N-acetylglucosaminidase F1 (Endo F1) is an endoglycosidase, secreted by Flavobacterium meningosepticum, that cleaves asparagine-linked oligosaccharides after the first N-acetylglucosamine residue. The enzyme is selective for high-mannose oligosaccharide chains. The crystal structure of Endo F1 has been determined at 2.0-A resolution. The molecular fold consists of a highly irregular alpha/beta-barrel, a commonly observed motif consisting of a cyclic 8-fold repeat of beta-strand/loop/alpha-helix units with an eight-stranded parallel beta-barrel at the center. Endo F1 lacks two of the alpha-helices, those of units 5 and 6. Instead, the links after beta-strands 5 and 6 consist of a short turn followed by a section in an extended conformation that replaces the helix and a long loop at the bottom of the molecule. The absence of any excursion on top of the molecule following beta-strands 5 and 6 results in a pronounced depression in the rim of the barrel. This depression forms one end of a shallow cleft that runs across the surface of the molecule, over the core of the beta-barrel to the area between the loops of units 1 and 2. The active site residues, Asp130 and Glu132, are located at the carboxyl end of beta-strand 4 and extend into this cleft. These residues are surrounded by several tyrosine residues. The cleft area formed by loops 1 and 2 is lined with polar residues, mainly asparagines. The latter area is thought to be responsible for oligosaccharide binding and recognition while the protein moiety of the substrate would be located outside the molecule but adjacent to the area of loops 5 and 6.(ABSTRACT TRUNCATED AT 250 WORDS)

Biochemical and molecular teratology of fetal hydantoin syndrome

Animal and human research has clearly shown that anticonvulsants are teratogens and pose a risk for fetal malformations. In the case of dilantin it appears that fetal susceptibility correlates with the fetal level of the microsomal detoxifying enzyme epoxide hydrolase. The genetics of seizures in the parents does not predict the risk for fetal teratogenesis. The clinician must work with a mother who has seizures prior to conception to achieve the best control of seizures with a single anticonvulsant at the lowest effective dose to minimize the teratogenic potential, but even if this is done there is still a risk of fetal malformations and developmental delays. Each pregnancy in a woman on anticonvulsants is at risk, and appropriate counseling should be accomplished before conception so the family can make an informed decision. The exact risk of teratogenesis is lower than previously recorded. Dilantin poses approximately a 10% risk, tegretol less than 10%, and valproic acid causes a threefold increase in the risk of neural tube defects as well as an increased risk of other malformations. The positive aspect is that with good medical management and good prenatal care approximately 90% of infants exposed to anticonvulsants in utero will not show evidence of teratogenesis. Finally, it is important to stress that all pregnancies carry a 3% risk for a major birth defect independent of any exposures or genetic history.

Late hemodynamic effects of the preserved papillary muscles during mitral valve replacement

BACKGROUND

The late hemodynamic effects of preserving the papillary muscles during mitral valve replacement have not been evaluated.

METHODS AND RESULTS

Sixteen patients who had chronic mitral regurgitation due to myxomatous degeneration were randomized to preservation (Pres group, n = 8) or no preservation (No Pres group, n = 8) of the chordae tendineae and papillary muscles during mitral valve replacement. Rest and exercise nuclear ventriculograms were performed early (3 months) and late (5 years) after surgery. Early after surgery, the No Pres group had lower ejection fractions and stroke work indexes (P < .05 by repeated-measures [rm] ANOVA) than the Pres group did at similar end-diastolic volume indexes. The No Pres group had similar cardiac indexes after exercise because heart rate increased (P < .005 by rm ANOVA). Late after surgery, ejection fraction was greater at similar end-diastolic volume indexes (P < .005 by rm ANCOVA), and preload recruitable stroke work indexes (P < .001 by rm ANCOVA) were better in the Pres group.

CONCLUSIONS

Preserving chordal attachments enhanced the late hemodynamic recovery after mitral valve replacement for mitral regurgitation.

Cryo-electron microscopy and three-dimensional reconstruction of the calcium release channel/ryanodine receptor from skeletal muscle

The calcium release channel (CRC) from skeletal muscle is an unusually large tetrameric ion channel of the sarcoplasmic reticulum, and it is a major component of the triad junction, the site of excitation contraction coupling. The three-dimensional architecture of the CRC was determined from a random conical tilt series of images extracted from electron micrographs of isolated detergent-solubilized channels prepared in a frozen-hydrated state. Three major classes of fourfold symmetric images were identified, and three-dimensional reconstructions were determined for two of these. The two independent reconstructions were almost identical, being related to each other by a 180 degrees rotation about an axis in the plane of the specimen grid. The CRC consists of a large cytoplasmic assembly (29 x 29 x 12 nm) and a smaller transmembrane assembly that protrudes 7 nm from one of its faces. A cylindrical low-density region, 2-3 nm in apparent diameter, extends down the center of the transmembrane assembly, and possibly corresponds to the transmembrane Ca(2+)-conducting pathway. At its cytoplasmic end this channel-like feature appears to be plugged by a globular mass of density. The cytoplasmic assembly is apparently constructed from 10 or more domains that are loosely packed together such that greater than 50% of the volume enveloped by the assembly is occupied by solvent. The cytoplasmic assembly is suggestive of a scaffolding and seems well adapted to maintain the structural integrity of the triad junction while allowing ions to freely diffuse to and away from the transmembrane assembly.

The effects of application of phosphatic fertilizer on cadmium concentration in ground waters around vineyards of Hyderabad

Cadmium is an important contaminant of superphosphate. Market samples of superphosphate revealed a concentration of cadmium in the range of 18.2-28.5 mg/kg. Application of periodic excess doses of superphosphate in vineyards 5-35 years old has led to elevated concentrations of cadmium in the ground water in the vineyards. Ground water samples from different vineyards analysed for cadmium by atomic absorption spectrophotometry revealed concentrations of cadmium in the range of 3.2-99.2 µg/I. These concentrations of cadmium in the ground water can be regarded as significant, since ground water serves as the only source of water for the vineyards.

Determinants of low systemic vascular resistance during cardiopulmonary bypass

Although low systemic vascular resistance occurs during normothermic and hypothermic cardiopulmonary bypass, the determinants of depressed systemic vascular resistance and its effect on outcomes are unknown. To assess the predictors and clinical effects of low systemic vascular resistance, 555 patients undergoing isolated coronary artery bypass grafting were evaluated prospectively. The extent of low systemic vascular resistance during bypass was estimated by the amount of the vasoconstrictor phenylephrine administered: group 1, 0 to 160 micrograms; group 2, 161 to 800 micrograms; group 3, more than 800 micrograms. Multivariate analysis identified bypass temperature, bypass time, and ventricular function as determinants of low systemic vascular resistance. Patients on normothermic bypass accounted for 65% of the patients in group 3 and only 34% of the patients in group 1 (p < 0.0001). The bypass time was longer in the patients in group 3 (97 +/- 28 minutes) than in the patients in group 1 (89 +/- 24 minutes; p < 0.006). Patients with a preoperative left ventricular ejection fraction of 0.40 or less required less phenylephrine during cardiopulmonary bypass (498 +/- 68 micrograms) than did patients with a fraction exceeding 0.40 (1,087 +/- 88 micrograms; p < 0.001). By multivariate analysis, advanced age and the presence of peripheral vascular disease were found to decrease the likelihood of low systemic vascular resistance during normothermic bypass. Diabetes, the left ventricular ejection fraction, the bypass time, and the total cardioplegia infused were found to influence the likelihood of low systemic vascular resistance during hypothermic bypass. Patients in group 3 had a higher cardiac index and lower-mean arterial pressure and systemic vascular resistance postoperatively. In those patients who received a left internal mammary artery graft, the incidences of the low-output syndrome (group 1, 4.9%; group 3, 2.7%; p = not significant) and myocardial infarction (group 1, 1.4%; group 3, 1.8%; p = not significant) were not influenced by the amount of phenylephrine infused during cardiopulmonary bypass. In those patients who were at high risk of suffering a stroke preoperatively, the hypotension induced by the low systemic vascular resistance and its treatment with phenylephrine was not associated with an increased incidence of stroke (group 1, 5.8%; group 3, 2.8%; p = not significant).

Cadmium levels in the urine of male sewage sludge farmers of Hyderabad, India

A study was conducted to evaluate the urinary cadmium levels among 45 nonsmoking sewage sludge farmers of different age groups and exposure. Urinary cadmium was analyzed following standard procedures on a flameless atomic absorption spectrophotometer. Cadmium concentrations were found to be significantly higher when compared with a nonsmoking general population of similar age group with no occupational exposure to cadmium. The mean concentration of 7.07 micrograms/L of cadmium was found in the farmers exposed to 25 yr of working on the sludge farms. Significantly higher concentrations of cadmium were also detected in the farmers exposed to 10 yr of working on sludge farms when compared with that of control groups.

Contrast sensitivity in diabetic retinopathy after panretinal photocoagulation

Reports of changes in contrast sensitivity in proliferative diabetic retinopathy (PDR) patients after panretinal photocoagulation (PRP) have considered only relatively short-term results, and these have been conflicting. We evaluated contrast sensitivity changes in 30 eyes of 29 PDR patients after PRP. The patients were divided into two groups. One, group A, received PRP at one sitting, and the other, group B, at two sittings. Before and at regular intervals after PRP, all of the patients underwent a battery of macular function tests for best-corrected visual acuity, color vision, contrast sensitivity, and photostress. Contrast sensitivity was significantly affected (P < .001) in both groups immediately after PRP, but stabilized to prelaser levels by the end of 3 months. Color-vision-error scores also were significantly higher (P < .001) immediately after PRP. Best-corrected Snellen visual acuity, however, remained stable at prelaser levels. Contrast sensitivity appears to provide a more sensitive measurement of visual acuity than the Snellen chart for monitoring foveal integrity in patients undergoing PRP.

Lack of self-regulation of human chorionic gonadotropin biosynthesis in human choriocarcinoma cells

Human gestational trophoblastic neoplasms overexpress hCG/LH receptors. Whether this overexpression is a reflection of a loss of self-regulation of hCG biosynthesis was investigated using JAR human choriocarcinoma cells. The results show that exogenous hCG did not affect steady state hCG alpha and hCG beta mRNA or dimer hCG protein levels in JAR cells. The JAR cells, however, responded to 8-bromo-cAMP with an increase in hCG alpha mRNA levels, suggesting that cAMP-mediated regulation of the hCG subunit genes was intact in the cells. Disruption of receptor function by a receptor antibody, which resulted in an increase in hCG alpha mRNA levels and hCG secretion in normal trophoblasts, had no effect on JAR cells. Unlike normal trophoblasts, which contain a predominant receptor transcript of 1.8 kilobases (kb), with minor higher molecular size (7.5 and 5.4 kb) transcripts occasionally seen, JAR cells contain a higher abundance of multiple transcripts (7.5, 5.4, 3.5, and 1.8 kb), with the predominant transcript being 5.4 kb. In addition, although normal trophoblasts contain an 80-kilodalton receptor protein, JAR cells contain only a 50-kilodalton hCG/LH receptor isoform. In contrast to the effects of exogenous hCG on normal placental tissue in vitro, it was unable to down-regulate receptor transcripts or receptor protein in JAR cells. In summary, JAR cells lack the ability to self-regulate hCG biosynthesis. This loss could explain how hCG can reach very high levels in gestational trophoblastic disease compared to those in normal pregnancy.

Crystallization and preliminary crystallographic analysis of two endo-beta-N-acetylglucosaminidases, endo H and endo F1

Endo H and F1 are endoglycosidases that cleave the oligosaccharide moiety of asparagine-linked glycoproteins by hydrolysis of the glycosidic bond in the N,N'-diacetylchitobiose core. The two enzymes are specific for high-mannose oligosaccharides. Here, we report the crystallization and preliminary crystallographic analysis of Endo H and Endo F1. Crystals were grown by hanging drop vapor diffusion methods. Both proteins crystallize from crystallization buffers containing polyethyleneglycol 8000 and zinc acetate as precipitating agents in cacodylate buffer. The crystals of Endo H belong to the tetragonal space group P4(1)2(1)2 (or P4(3)2(1)2) with cell dimensions: a = 85.22 A, c = 89.41 A. The crystals of Endo F1 belong to the hexagonal space group P6(1) (or P6(5)) with cell dimensions: a = 70.61 A, c = 100.32 A. Crystals of both proteins diffract to at least 1.8 A resolution.

Sudden death due to coronary artery anomalies: a case report and clinical review

Congenital anomalies of the coronary arteries are relatively uncommon conditions with an incidence of approximately 2% in the adult population. Although less common than acquired coronary artery disease, these anomalies may be associated with myocardial ischemia and its consequences; angina, arrhythmia, infarction, and sudden death. A 21-year-old female patient with no significant prior medical history was found dead at home. Postmortem examination revealed high take-off of the right coronary artery with acute down-ward angulation of the proximal right coronary artery and acute downward angulation of the left main coronary artery. Microscopic examination revealed global myocardial ischemia consistent with a terminal ventricular dysrhythmia. There was no evidence of any other disease processes. Detailed toxicological investigation was negative. The Regional Forensic Pathology Unit experience with sudden death due to congenital coronary artery anomalies is presented along with a review of the current literature.

Subconjunctival dislocation of posterior chamber intraocular lens

A posterior chamber intraocular lens (PC-IOL) dislocated into the subconjunctival space following a concussion injury in a 24-year-old man who had gained good visual acuity following extracapsular cataract extraction and PC-IOL implantation for a steroid-induced cataract. Except for long-term use of topical steroid therapy for vernal catarrh, the patient had no systemic or ocular predisposing factors for wound dehiscence. Given the risk of endophthalmitis, the PC-IOL was removed and anterior vitrectomy was performed on an emergency basis. To our knowledge, this is the second documented case of a subconjunctivally dislocated PC-IOL.

CT findings after uncomplicated and complicated laparoscopic cholecystectomy

Laparoscopic cholecystectomy (LC) is quickly becoming the standard procedure for gallbladder removal. Recent studies indicate that this new procedure compares favorably with open cholecystectomy in mortality and overall morbidity. Imaging has assumed an important role in the diagnosis and management of postoperative complications. This report reviews the CT findings after uncomplicated LC as well as the spectrum of CT findings seen with various postoperative complications.

Staff pharmacists' opinions about performance appraisals

Staff pharmacists' knowledge of the performance appraisal (PA) process at their hospitals and their satisfaction with the process were studied. A two-page questionnaire was mailed to staff pharmacists at 11 hospitals located around the country, and a pharmacy administrator at each hospital was interviewed. A total of 142 staff pharmacist surveys were returned. Staff pharmacists' responses about the PA process were then compared with the responses given by their pharmacy administrator. Comparison of responses showed a low percentage of agreement for many items. When process measures were compared with satisfaction scores, the results indicated that staff pharmacists are more satisfied with the PA process when a written performance plan is used and when they receive feedback about their performance throughout the year. Managers should orient staff pharmacists to the PA process that will be used to evaluate them. Written plans for improving performance and frequent feedback about performance may increase staff pharmacists' satisfaction with the PA process.

Recent advances in IOL surgery

Tremendous progress is made in recent time in the field of Ophthalmology especially after advent of IOL implantation surgery. Recent advance in anaesthesia/IOL, designs/IOL, quotings/cantering, techniques/advances in operating microscope and advances in suture materials/needles etc. will be discussed.

Immediate free tissue transfer for distal musculoskeletal neoplasms

Sarcomas and other aggressive neoplasms of the extremities present particular challenges for limb salvage when the tumors are located distally in the arms or legs. These tumors require a large area of excision, yet there are no suitable options for local tissue coverage. In the past, amputation was often necessary due to the inability to adequately reconstruct the extremity. We performed immediate free tissue transfers on 10 patients with aggressive tumors in the forearm and lower leg. Eight patients had sarcomas, 1 had a melanoma, and 1 had a recurrent fibromatosis. Seven patients had rectus abdominis flaps, 1 had a latissimus dorsi flap, 1 had a groin flap, and 1 had an osteocutaneous flap from the iliac crest. Three patients had tendon transfers at the time of surgery. Four patients required radiation therapy after resection due to the high-grade nature of their neoplasms. The flaps tolerated the radiation well, with only 1 patient sustaining flap necrosis that required skin grafting. Average follow-up was 28 months. All patients are alive and none had local recurrences of their tumors. All free flaps have survived and remained durable. There have been no late breakdowns of skin grafts, and all tendon transfers have functioned well. Immediate free tissue transfer provides an excellent method of reconstruction for distal tumors of the extremities.

Does coronary endarterectomy adversely affect the results of bypass surgery?

Coronary endarterectomy (TEA) is performed infrequently during coronary artery bypass graft (CABG) surgery due to the impression that it results in higher rates of myocardial infarction (MI), operative mortality (OM), and poor long-term outcome. To assess the effectiveness of TEA, 1,228 patients undergoing isolated CABG between 1982 and 1989 were evaluated. The incidence of OM (3.2%) and MI (6.0%) following TEA was similar to conventional CABG (OM = 3.8%, MI = 5.5%, p = NS). The incidence of low output syndrome (LOS, 15.1%) and intraaortic balloon pump insertion (IABP, 4.5%) following TEA was similar to conventional CABG (LOS = 12.6%, IABP = 6.0%, p = NS). The highest level of the cardiac specific isoenzyme (CK-MB) released following surgery was similar for the TEA group (46 +/- 49) and conventional CABG group (42 +/- 44, p = NS). Ventricular dysfunction, urgent surgery, left main stenosis, advanced age, and reoperative surgery were similar in the TEA and conventional CABG groups. At a mean follow-up of 4.2 years, 65.6% of all TEA patients were free of angina, 44.4% were gainfully employed, and 62% were in New York Heart Association Class I. The incidence of late myocardial infarction was 5.4%. The 5-year actuarial survival was 90%. Patients with double TEA and limited TEA ( < or = 3 cm TEA specimens) tended to have a lower 5-year survival. With strict criteria for selection of TEA patients and with significant technical experience, the short- and long-term results of TEA are comparable to conventional CABG.

The expression of human chorionic gonadotropin/luteinizing hormone receptors in human endometrial and myometrial blood vessels

hCG/human LH (hLH) receptors have recently been found in human endometrial and myometrial cells and uterine vasculature. The present study was undertaken to further corroborate the immunocytochemical evidence for the presence of vascular receptors. Northern blot and in situ hybridization analyses have revealed that human uterus contains a major 4.3-kilobase and a minor 2.6-kilobase hCG/hLH receptor mRNA transcript and that these transcripts are present in part in endometrial and myometrial vascular smooth muscle cells and vascular endothelial cells. Immunoblot and immunocytochemical analyses have revealed that human uterus also contains a single immunoreactive receptor protein, and that this receptor protein in part is present in endometrial and myometrial vascular smooth muscle and vascular endothelium. The expression of receptor mRNA and/or immunoreactive receptor protein was higher in myometrial than in endometrial blood vessels, and higher in vessels of both uterine compartments from the secretory compared to proliferative phase, postmenopause, or pregnancy. The blood vessels in omentum, broad ligament, and parametrium did not immunostain for hCG/hLH receptors. A blood vessel seen traversing through parametrium immunostained for the receptor protein only after it entered the myometrium. The blood vessels in nontarget tissues did not immunostain, whereas those in some target tissues, but not all of them, immunostained for the receptor protein. In summary, the present study demonstrates for the first time that human endometrial and myometrial vascular smooth muscle and endothelium express hCG/hLH receptor mRNA and immunoreactive receptor protein. These findings suggest that hCG/hLH may directly regulate blood flow in human uterus and other target tissues. The reproductive state dependency of uterine vascular receptors suggests that these receptors are probably regulated by other reproductive hormones.

Mitral valve replacement: mechanical versus bioprosthetic valves--a clinical review

A review of the literature was conducted in an attempt to justify the exclusive use of either mechanical or tissue prostheses in the mitral position. In addition, the University of Toronto experience with mitral valve replacement was reviewed, including a five year follow-up from the Toronto General Hospital. Both studies concluded that there was no significant advantage for the use of either type of valve based upon freedom from thromboembolism, freedom from anticoagulant-related hemorrhage and freedom from all valve-related mortality/morbidity. Tissue valves were shown to be significantly poorer substitutes in terms of freedom from primary valve failure (P less than 0.05) and freedom from reoperation due to valve-related complications (P less than 0.07). The clinical results from the Toronto General Hospital correlated with those reported in the literature and suggested the preferential use of mechanical valves during mitral valve replacement based primarily on their durability and a consequent lesser need for reoperation.

The galactose-binding sites of the cytotoxic lectin ricin can be chemically blocked in high yield with reactive ligands prepared by chemical modification of glycopeptides containing triantennary N-linked oligosaccharides

A glycopeptide containing a triantennary N-linked oligosaccharide from fetuin was modified by a series of chemical and enzymic reactions to afford a reagent that contained a terminal residue of 6-(N-methylamino)-6-deoxy-D-galactose on one branch of the triantennary structure and terminal galactose residues on the other two branches. Binding assays and gel filtration experiments showed that this modified glycopeptide could bind to the sugar-binding sites of ricin. The ligand was activated at the 6-(N-methylamino)-6-deoxy-D-galactose residue by reaction with cyanuric chloride. The resulting dichlorotriazine derivative of the ligand reacts with ricin, forming a stable covalent linkage. The reaction was confined to the B-chain and was inhibited by lactose. Bovine serum albumin and ovalbumin were not modified by the activated ligand under similar conditions, and we conclude, therefore, that the reaction of the ligand with ricin B-chain was dependent upon specific binding to sugar-binding sites. Ricin that had its galactose-binding sites blocked by the covalent reaction with the activated ligand was purified by affinity chromatography. The major species in this fraction was found to contain 2 covalently linked ligands per ricin B-chain, while a minor species contained 3 ligands per B-chain. The cytotoxicity of blocked ricin was at least 1000-fold less than that of native ricin for cultured cells in vitro, even though the activity of the A-chain in a cell-free system was equal to that from native ricin. Modified ricin that contained only 1 covalently linked ligand was also purified. This fraction retained an ability to bind to galactose affinity columns, although with a lower affinity than ricin, and was only 5- to 20-fold less cytotoxic than native ricin.

Analysis of human chromosome 21: correlation of physical and cytogenetic maps; gene and CpG island distributions

Human chromosome 21 has been analyzed by pulsed-field gel electrophoresis using somatic cell hybrids containing limited regions of the chromosome and greater than 60 unique sequence probes. Thirty-three independent NotI fragments have been identified, totalling 43 million bp. This must account for essentially the entire long arm, and therefore gaps remaining in the map must be small. The extent of the pulsed-field map has allowed the direct correlation of the physical map with the cytogenetic map: translocation breakpoints can be unambiguously positioned along the long arm and the distances between them measured in base pairs. Three breakpoints have been identified, providing physical confirmation of cytogenetic landmarks. Information on sequence organization has been obtained: (i) 60% of the unique sequence probes are located within 11 physical linkage groups which can be contained in only 20% of the long arm; (ii) 9/21 genes are clustered within 4%; (iii) translocation breakpoints appear to occur within CpG island regions, making their identification difficult by pulsed-field techniques. This analysis contributes to the human genome mapping effort, and provides information to guide the rapid investigation of the biology of chromosome 21.

Conjunctival impression cytology for assessment of vitamin A status

Ocular signs and serum vitamin A concentrations are commonly used for the diagnosis of vitamin A deficiency. Recently, impression cytology was suggested as a method for early detection of this condition. A clinical trial was conducted to compare the results of impression cytology with the other two indicators of vitamin A status. A total of 246 children aged 1-10 y were investigated. About 25% of the children with normal eyes showed abnormal cytology. Their mean vitamin A concentrations were significantly lower compared with those with normal cytology, which suggests that abnormal cytology reflects subclinical deficiency. After treatment with vitamin A, most of the children who had abnormal cytology at baseline examination showed improvement. These observations suggest that abnormal cytology is specific to vitamin A deficiency. Impression cytology is a relatively simple technique and can be used for assessing the magnitude of the problem, especially in communities where the prevalence of clinical disease is low.

Acetylsalicylic acid dose fails to affect energy intake of osteoarthritic elderly

The objective of the study was to determine the effect on energy intake and appetite of acetylsalicylic acid (ASA), commonly used by the elderly to treat arthritis. In a double blind cross-over study, 23 free-living osteoarthritic patients 60 years of age or older were treated for two-weeks intervals with a mean daily ASA intake of 2.44 and 1.29 grams, respectively. Twenty healthy persons similar in age, taking no medication, and matched in sociocultural characteristics were included as a control group. Appetite was measured directly, using a visual analogue scale, and indirectly by calculating energy intake from three-day food records. Varying the dose of ASA was without effect on appetite and food energy intake; however, as appetite was rated lower by the medicated osteoarthritic than by the healthy group, although the energy intakes were not significantly different, the former should be considered as potentially at nutritional risk.

Diet, mortality and life expectancy: a cross national analysis

"There are numerous reasons why mortality and life expectancy vary between countries. Epidemiological studies seem to indicate that dietary variations may be among them. A sample of 51 countries studied with data from the International Comparisons Project and other sources, shows that after controlling for nutrient intake, consumption of medical goods and services, income distribution, weather, and literacy, countries with more meat and poultry in their diet have lower life expectancies after age five. The results for infant mortality and child death between one and five indicate that a more animal-intensive diet may be actually beneficial, especially if fish consumption is increased and meat and poultry consumption reduced."

Various manifestations of hyperthyroidism in an ambulatory clinic: case studies

This study reviews five cases of women with hyperthyroidism, three black women and two Hispanic women. Initially, two patients presented with voice changes, weight loss, and increased appetite. Only two patients presented with classical symptoms of hyperthyroidism. Examination showed all patients had diffusely enlarged thyroids and exaggerated reflexes. Two patients showed Graves' opthalmopathy.These cases document the variety of presentations of hyperthyroidism. Hence, a high index of suspicion must exist for this disease, even in the absence of a number of the classical manifestations of hyperthyroidism. When patients present to primary care centers with a constellation of symptoms, an examination of the thyroid gland is essential.

The pathology and pathogenesis of Salmonella stanley infection in experimental chicks

Experimental infection with Salmonella stanley was produced by oral, intravenous and intramuscular routes in day-old chicks. The earliest evidence of the presence of the organisms was in duodenal mucosa six hours after oral infection. Following oral infection the organisms were detected in the duodenum from six hours to five days, in the caecum from 12 hours to nine days, liver, spleen and blood from 24 hours to seven days. The resistance to infection was found to be significant after 10 days old, but not up to six days old. The work confirmed that the survival time of birds given S stanley by the intravenous or intramuscular routes was inversely proportional to the dose up to a maximum beyond which the survival time was not further decreased by dose increase. The presence of S stanley in tissues and blood was detected by isolation and by the fluorescent antibody technique.

Conjunctival goblet cells and mitotic rate in children with retinol deficiency and measles

To study the effect of retinol deficiency and measles on the conjunctival epithelium, we determined the epithelial mitotic rate (MR) and goblet cell frequency (GCF) in conjunctival biopsy specimens from preschool children in Hyderabad, India. We studied three groups of children: normal appearing, clinically retinol deficient (defined by the presence of superficial fine punctate keratitis), and clinically retinol deficient with measles. The last group was subdivided into those with low serum retinol levels (less than or equal to 20 micrograms/dL [less than or equal to mumol/L]) and those with normal serum retinol levels (greater than 20 micrograms/dL [greater than 0.70 mumol/L]). In the control group of seven normal-appearing children with a mean age of 4.6 years, the mean MR was 1.3% +/- 0.4%, and the mean GCF was 8.0% +/- 3.6% of the basal epithelial cells. In seven children with clinical retinol deficiency, the mean MR was 15.4% +/- 1.2%, and the mean GCF was 1.0% +/- 0.5%, values significantly different from normal ones. Among 11 children with clinical retinol deficiency, measles, and low serum retinol levels, the mean MR was 9.0% +/- 1.9%, and the mean GCF was 3.1% +/- 1.1%, values not statistically different from those in children with clinical retinol deficiency alone. Five children with clinical retinol deficiency, measles, and normal serum retinol levels had a mean MR of 10.2% +/- 3.7% and a mean GCF of 1.9% +/- 1.7%, values similar to those in the other disease groups. This indicates that retinol deficiency sufficient to cause clinical signs without subepithelial scarring or keratinization is associated with hyperproliferation of the conjunctiva whether or not there is a superimposed measles infection.

Diagnosis of hyperthyroidism in patients with thyroiditis: a case study

A diagnosis of subacute thyroiditis can be difficult to make in the early stages of disease, especially when patients present with symptoms of a hyperthyroid state that are nonspecific and mild. Using three case histories, the authors demonstrate how an early diagnosis of thyroiditis was made in these patients.

Relationship between measles, malnutrition, and blindness: a prospective study in Indian children

A prospective study was conducted in slum children to determine the incidence of post-measles corneal disease and to clarify its relationship with nutritional status. A total of 318 cases of measles were identified over a period of 15 mo; maximum incidence was observed for children between 1-2 yr. Most of the children showed weight loss and serum proteins decrease during the acute stage of measles. Corneal lesions were observed in 3% of the children, and the lesions responded well to treatment. Serum vitamin A and RBP levels were significantly depressed during the acute stage of measles but were restored to normal 8 wk after recovery. There were no significant differences in the serum levels for those with and without eye lesions, which suggests that these lesions may not be mediated simply through the effect of infection on serum concentration of vitamin A.

Syndrome of galactorrhea, amenorrhea, and obesity as possible indicators of prolactinoma: a case study approach

Four female patients were found to have microadenomas and high prolactin levels, but the symptoms of the syndrome varied among the patients. Three of four patients had overt galactorrhea, obesity, and amenorrhea. One patient was postmenopausal, and another showed menstrual irregularities. Two patients sought medical attention for headaches, and one for visual disturbances. Two patients previously had used psychotropic drugs, and two patients used birth control pills. When tested, all patients had high serum prolactin levels, abnormal sellar tomograms, and the presence of microadenoma of the pituitary was confirmed by computerized tomography.Because of the high incidence of pituitary tumor among these four patients, this study suggests that a complete workup should be done for patients having galactorrhea, amenorrhea, and obesity as a syndrome or as separate entities.

MRI of joint fluid in the normal and ischemic hip

MR images in 36 hips with documented avascular necrosis and 80 hips without evidence of joint disease were studied to determine the amount and appearance of fluid in the joint. All MRI examinations were done on a 1.5-T machine and included coronal images made with relative T2 weighting (repetition times = 2000-2500 msec, echo delays = 60-100 msec). The amount of joint fluid, which had an intense signal higher than fat, was graded from 0 to 3 and analyzed with respect to the patient's age and radiographic stage of avascular necrosis. Joint fluid was seen in 84% of presumed normal hips. Only four (5%) of 80 had enough fluid to surround the femoral neck (grade 2), and none had sufficient fluid to distend the joint capsule (grade 3). In comparison, 21 (58%) of 36 hips with avascular necrosis had grade-2 or grade-3 effusions (p less than 0.005), and some fluid was seen in all. Grade-3 effusions were seen in seven (50%) of 14 hips with flattening of the femoral head, compared with only one (5%) of 20 in which the femoral contour was normal. It is concluded that small amounts of fluid are present in both normal hips and those with avascular necrosis. In avascular necrosis, increased joint fluid may be present before radiographic abnormalities occur, but it is greatest after there is flattening of the femoral head. MRI is a highly sensitive method for detecting fluid in the hip joint.

Pathogenesis of corneal lesions in measles

The mechanism of pathogenesis underlying the development of corneal lesions in measles was investigated in 125 children suffering from measles and 66 age- and sex-matched healthy controls. Forty age-matched children with bronchopneumonia were investigated on similar lines to delineate the role played by vitamin A and measles individually in the development of corneal lesions. The results indicate that the pathogenesis of corneal lesions in measles is indeed multifactorial. Vitamin A deficiency alone or measles keratitis per se may not explain the mechanism completely. The immunosuppression induced by the local proliferation of the measles virus in the eye might trigger the invasion of pathogenic microbes which damage the cornea. The structural integrity of the cornea is already compromised by vitamin A deficiency and lesions of measles keratitis.

Effect of dopamine and dopamine-receptor blockade on in vitro renin release, tissue renin content and tissue cyclic AMP content in the rat

This study evaluated the in vitro renin release, tissue cyclic AMP content (TcAMPc), and tissue renin content (TRC) changes with time, in response to administration of dopamine (DOP) and of the dopamine-receptor blocking agent pimozide (PIM) to renal cortical slices from sodium deficient (SD) rats. Addition of 10(-3)M DOP to the slice preparation resulted in a gradual stimulation of RR with time, which was significantly different from that seen in control samples after 60 min of incubation. In contrast, TcAMPc of the DOP-treated samples was significantly greater than that of controls after 5 min of incubation. At 60 min, mean TRC of DOP-treated samples was greater than that of controls but not significantly. Two PIM doses (10(-8)M and 10(-6)M, whether added alone or together with 10(-3)M DOP to the cortical slice system, significantly increased RR in each instance while simultaneously depressing TcAMP content markedly below that of unstimulated controls at all incubation times examined. Mean TRC of pimozide-treated samples was also lower than that of controls by 60 min. These in vitro data in the SD rat suggest that: 1) stimulation of renin release by DOP is time-dependent and is mediated by a TcAMP-generating mechanism, and 2) the increase in renin release by PIM administration appears to involve pharmacological inactivation of TcAMP-generating pathways and disruption of membrane permeability, leading to uncontrolled RR.

Factors affecting neurobehavioral responses of preterm infants at term conceptional age

A revised Prechtl Neurological Examination was administered to 510 singleton infants at term conceptional age to assess the influence of gestational age, race, and sex on neurobehavioral responses in a "typical" newborn population. The infants were born at 1 of 5 centers and were subjects of the NIH Collaborative Study on Antenatal Steroid Therapy. Of these babies, 392 were born at less than 37 weeks gestational age, whereas 118 infants were born at greater than or equal to 37 weeks. Of a total of 50 items of interest, 12 differed significantly based on race, 14 items differed in terms of gestational age at birth, and 5 items were influenced by the sex of the baby. These data suggest that singleton preterm infants born at differing gestational ages should not be considered to comprise a homogeneous sample. Further, caution should be exercised when considering babies of heterogeneous race groupings, and the babies' sex has minimal impact on neurobehavioral responses at term conceptional age.

The Minnesota diabetes complications clinical trial. The first three years

A prospective and randomized clinical trial of an inception cohort of diabetic kidney recipients to test the hypothesis that maximized metabolic control of diabetes prevents or delays diabetic nephropathy in the renal allografts was initiated approximately three years ago. Notwithstanding the fact that all our diabetic patients were on prednisone and therefore metabolically unstable, we achieved and maintained a clear difference between the standard control (group A) and the maximized control patients (group B). At 13 months of study, the mean fasting blood glucose mg% (A: 242 +/- 22, B: 130 +/- 9, p less than 0.001), nonfasting blood glucose (A: 276 +/- 40, B: 135 +/- 10, p less than 0.001), 24 hour urine glucose (A: 85 +/- 16, B: 5 +/- 1, p less than 0.001), and glycosylated hemoglobin % (A: 13 +/- 0.9, B: 10 +/- 0.8, p less than 0.01) were all clearly and statistically significantly higher for the group A patients. These results show the feasibility of such a trial using the tools available today to treat diabetes.

[Na+ and K+ in the rabbit aqueous humor after treatment with timolol]

The influence of timolol on aqueous humour production has been well documented, nevertheless it is unknown the real mechanism by which timolol produces this process. We have conceived the hypothesis that any alteration of natrium and kalium content following topical treatment of timolol was the main cause of the lowering rate of aqueous humour production. Therefore, we have examined the behaviour of Na+ and K+ amounts after topical administration of one eye of young rabbits with timolol. The experimentation has been conducted by photometer appliance. Our results show the absence of any imbalance between natrium and kalium content. The failure of our purpose indicates that Na+/K+ content does not play a main role in decreasing aqueous humour production by timolol.