Surgical Treatment of Interstitial Cystitis in Women

Interstitial cystitis is a clinical entity that has been known for a century, but its pathophysiology remains largely unknown and the optimal treatment is a matter of ongoing discussion. A successful strategy for treatment relies on precise appraisal of symptoms, clinical findings and histology, as well as on the patient’s individual personality. The least invasive treatment possible should be chosen, and only after conservative options have been exhausted should a surgical solution be considered. In this respect, anatomical bladder capacity plays an important role. A large capacity indicates the potential for conservative treatment and may be regarded as a negative predictor for the outcome of orthotopic bladder substitution. In contrast, a small anatomical capacity is unlikely to respond to conservative therapy, but is associated with a high probability of successful orthotopic bladder substitution.     

Immunohistochemical detection of p53 in differentiated, poorly differentiated and undifferentiated carcinomas of the thyroid

In an attempt to find whether or not p53 immunoreactivity in the thyroid gland is restricted to undifferentiated carcinomas and to evaluate the putative prognostic usefulness of its detection, we investigated p53 immunoreactivity in a series of 14 benign thyroid lesions and 65 thyroid carcinomas (12 papillary; six minimally invasive follicular; four widely invasive follicular; 31 poorly differentiated and 12 undifferentiated tumours). Unequivocal nuclear immunostaining for p53 was observed in two widely invasive follicular carcinoma (20.0%), five poorly differentiated carcinomas (16.1%) and in 10 undifferentiated carcinomas (83.3%). The percentage of immunoreactive cells was much smaller in the former groups than in undifferentiated carcinomas. Despite a trend to a more aggressive behaviour of the p53 immunoreactive cases no significant differences in the outcome of patients with positive and negative tumours was found when the comparison was made within each category of carcinomas. We conclude that p53 immunoreactivity can be detected both in undifferentiated carcinomas and in some differentiated and poorly differentiated thyroid carcinomas. Larger series of cases are necessary to evaluate the prognostic usefulness of this finding.     

The mucosal immune system in IgA nephropathy

Summary: IgA nephropathy is a clinically and histologically defined syndrome of unknown aetiology, which may have various causes in different parts of the world. Immunologically it is characterized by deposition of IgA1, probably polymeric IgA, in the mesangium and is frequently associated with IgG, C3 and components of the alternative pathway of the complement cascade. the disease can go into complete remission in children, but in adults it usually has a progressive course, characterized by the appearance of proteinuria and hypertension and loss of glomerular filtration rate (GFR). Histologically the development of glomerulosclerosis and tubulo-interstitial changes correlate with a clinical progressive course. the mucosal immune system is characterized by high plasma IgAl antibody responses after parenteral immunization with viral or bacterial vaccines. However, following nasal challenge with a bacterial neoantigen, IgA nephropathy patients appear to have a defective mucosal immune response in their nasal washes, in their bone marrow and in their plasma IgA1 antibody levels.     

Work outcome in workers with occupational skin disease

We carried out a follow-up study of employment outcome for 230 workers with a diagnosis of occupational skin disease who were at least 2 years postdiagnosis. Seventy-eight percent of the workers were working, but 57% of those working had changed jobs, 67% because of their skin problem. Thirty-one percent had lost no time from work because of their skin disease, while 35% had lost at least 1 month. Forty-three percent had applied for workers' compensation benefits, and 87% of those who had applied were successful in their claims. Older workers were more likely to be unemployed and to have applied for workers' compensation benefits. Women were less likely to have lost time from work and to have applied for workers' compensation. Those who had changed their jobs tended to have a better outcome with respect to active dermatitis, though they had lost more time from work and had more often applied for workers' compensation benefits.     

Mapping the neural systems that mediate the Paced Auditory Serial Addition Task (PASAT).

The paced auditory serial addition task (PASAT), in which subjects hear a number-string and add the two most-recently heard numbers, is a neuropsychological test sensitive to cerebral dysfunction. We mapped the brain regions activated by the PASAT using positron emission tomography (PET) and 15O-water to measure cerebral blood flow. We parsed the PASAT by mapping sites activated by immediate repetition of numbers and by repetition of the prior number after the presentation of the next number in the series. The PASAT activated dispersed non-contiguous foci in the superior temporal gyri, bifrontal and biparietal sites, the anterior cingulate and bilateral cerebellar sites. These sites are consistent with the elements of the task that include auditory perception and processing, speech production, working memory, and attention. Sites mediating addition were not identified. The extent of the sites activated during the performance of the PASAT accounts for the sensitivity of this test and justifies its use in a variety of seemingly disparate conditions.     

Clinical features and risk factors for striae distensae in Korean adolescents

BACKGROUND: Despite the high prevalence of striae distensae, clinical studies are few in number, and their pathophysiology still obscure. OBJECTIVES: To determine the prevalence and clinical characteristics of striae distensae that occur in Korean adolescents, and to correlate their clinical features with family history, other dermatological conditions, and body measurements. METHODS: One hundred and fifty-seven healthy Korean students, aged 15 to 17, were studied. A questionnaire and physical examination were employed to assess the subjects' past and family history, and the distribution, clinical features and severity of striae distensae. RESULTS: Striae distensae were present in 131 subjects (83.4%). Ninety-four (88.2%) of 109 male and 37 (77.1%) of 48 female subjects were affected. The striae were white in colour in 69.5% and asymptomatic in most of the subjects. They developed at an average age of 13.8 years. Family history was present in 18 subjects (11.5%). Seborrhoea of the face was positively correlated (P < 0.035) with striae distensae, and atopic dermatitis negatively correlated (P < 0.001). In both sexes, the buttock was the most prevalent area of striae development, followed by the lower back and knee in boys and by the thigh and calf in girls. Striae were significantly more common on the thigh of girls and on the knee of boys. CONCLUSIONS: Our results indicate that striae distensae are a common skin condition that occurs early in puberty regardless of gender, and that they have a different anatomical distribution and relationship with body measurements in each gender.     

Acute effects of transcutaneous electric nerve stimulation on self-injurious behavior

The purpose of this study was to determine the acute effects of conventional mode transcutaneous electric nerve stimulation (TENS) on the rate of selfinjurious behaviors (SIB) in two young multiply handicapped persons with mental retardation. The first individual exhibited high rates of severe selfbiting. In an alternating treatments design the TENS unit was randomly switched on or off in two daily sessions. In initial open trials SIB appeared to be clearly suppressed by TENS. During blind trials, in which the observers were kept uninformed as to the TENS status, frequency of biting was still slightly lower during active TENS conditions as compared to TENS-off conditions. The rate of a second maladaptive behavior (finger gouging) was not affected by TENS. The second individual exhibited high frequency of head banging. Two sessions, consisting of two conditions each, were scheduled daily throughout the study. During baseline periods the TENS unit was switched off. During the alternating treatments phases the unit was alternatively switched on or off in a random and predetermined fashion. The data indicate that head hitting rates were reduced by TENS, and that four concurrently recorded behaviors were unaffected by the TENS. It was concluded that TENS had selective effects on SIB in both individuals without achieving clinically significant results. TENS effects were found to continue for some time after the unit was switched off. The data are discussed as to their scientific and clinical implications.