Negative Q-tip test as a risk factor for failed incontinence surgery in women

Fifteen women with a clinical and urodynamic diagnosis of stress urinary incontinence had a negative Q-tip test (greater than or equal to 30 degrees Q-tip angle change on straining). All 15 had retropubic surgical procedures for stress incontinence in the form of a revised Pereyra procedure (n = 6) or Burch retropubic urethropexy (n = 9). Five of the nine patients undergoing the Burch procedure (55%) and three of the six undergoing the Peyreya procedure (50%) failed the procedure, for an overall failure rate of 53%. This rate was five times higher than that among women with stress urinary incontinence and a positive Q-tip test who underwent the same procedures (P less than .01). We conclude that women with stress urinary incontinence and no anatomic defect in the support of the urethrovesical junction should not undergo retropubic procedures because of their high failure rate. Other occlusive procedures, such as sling operations, should be considered for this group.     

Cause of hearing loss in the high-risk premature infant

Bilateral hearing loss occurred in 9.7% of infants who survived despite very low birth weight (less than or equal to 1500 gm), 16.7% of infants who survived neonatal seizures, and 28.6% of infants who survived both low birth weight and neonatal seizures. All neonates received treatment in a single neonatal intensive care unit between 1976 and 1980. Twenty-two of 36 hearing-impaired children were normal physically and mentally, with IQ scores of greater than or equal to 85. Significant neonatal predictors of hearing loss in high-risk premature infants (less than or equal to 36 weeks gestation), as determined by multivariable testing, were prolonged respirator care, high serum bilirubin concentration, and hyponatremia. Exchange transfusions were associated with a decreased risk of hearing loss.     

In Vitro Inhibition of Thyroid Hormone Sulfation by Polychlorobiphenylols: Isozyme Specificity and Inhibition Kinetics

It was recently demonstrated by our laboratory that hydroxylatedmetabolites of polychlorinated biphenyls (PCB-OHs) are inhibitorsof thyroid hormone sulfation. In this study, a more detailedinvestigation on sulfotransferase isozyme specificity and thekinetics of inhibition was performed. Thyroid hormone sulfationwas determined using 3,3'-diiadothyronine (T2) as a substrate,and various sources of sulfotransferase (SULT) enzyme were used;e.g., female and male rat liver cytosol, male brain cytosoland cytclsolic preparations of V79 cells transfected with ratSULT1C1, and human SULT1A1 and human SULT1A3. The inhibitionpattern and IC50 values were very similar for male and femalerat liver and rSULT1C1 and hSULT1A1. PCB-OHs were not able toinhibit the T2 sulfotranferase activity using hSULT1A3. Metabolite3-hydroxy-2,3',4,4',5-pentachlorobiphenyl did not inhibit T2sulfotransferase activity in male brain cytosol, while it wasa very potent inhibitor in male and female rat liver cytosol.IC50 values for the tested PCB-OHs were not different with eitherT2 or 3,3',5-triiodothyronine (T3) as substrate, supportingthe hypothesis that T2 is the preferred iodothyronine substratefor the sulfotransferases catalyzing the sulfation of the activehormone T3. The Lineweaver-Burk plot obtained with rat livercytosol and T2 suggested that the nature of the T2 sulfationinhibition by 4-hydroxy-2',3,3',4',5-pentachlorobipheny is competitive.Finally, it was demonstrated that tested hydroxylated polychlorinateddibenzo-p-dioxins and biphenyls were, albeit poorly, sulfatedby sulfotransferases as measured by the production of ³⁵S-labeledmetabolites.     

Longitudinal compensation for fat-induced insulin resistance includes reduced insulin clearance and enhanced beta-cell response

Central adiposity is highly correlated with insulin resistance, which is an important risk factor for type 2 diabetes and other chronic diseases. However, in normal individuals, central adiposity can be tolerated for many years without development of impaired glucose tolerance or diabetes. Here we examine longitudinally the mechanisms by which glucose tolerance can be maintained in the face of substantial insulin resistance. Normal dogs were fed a diet enriched with moderate amounts of fat (2 g x kg(-1) x day(-1)), similar to that seen in modern "cafeteria" diets, and the time course of metabolic changes in these animals was examined over 12 weeks. Trunk adiposity as assessed by magnetic resonance imaging increased from 12 to 19%, but body weight remained unchanged. Insulin sensitivity (SI) as determined by frequently sampled intravenous glucose tolerance tests was measured over a 12-week period. SI decreased 35% by week 1 and remained impaired for the entire 12 weeks. Intravenous glucose tolerance was reduced transiently for 1 week, recovered to baseline, and then again began to decline after 8 weeks. First-phase insulin response began to increase after week 2, peaked by week 6 (190% of basal), and then declined. The increase in insulin response was due partially to enhanced beta-cell function (22%) but due also to an approximately 50% reduction in insulin clearance. This compensation by insulin clearance was also confirmed with insulin clamps performed in fat-fed versus control dogs. The present study confirms the ability of the normal individual to compensate for fat-induced insulin resistance by enhanced insulin response, such that the product of insulin sensitivity x secretion is little changed. However, the compensation is due as much to reduced insulin clearance as increased beta-cell sensitivity to glucose. Reduced hepatic extraction of insulin may be the first line of defense providing a higher proportion of secreted insulin to the periphery and sparing the beta-cells during compensation for the insulin-resistant state.     

A comparative trial of skin donor site dressings

Summary Skin donor sites dressed with Opsite—an adhesive polyurethane surgical drape, permeable to gases and water vapour only—heal faster and with less pain than those covered with the conventional paraffin gauze dressing. This is largely due to the moist environment which is present under the Opsite drape.     

Developmental changes in startle reactivity in school-age children at risk for and with actual anxiety disorder

The present study examined the development of elevated startle reactivity in anticipation of mild anxiogenic procedures in school-age children with current anxiety disorders and in those at-risk for their development due to parental anxiety. Startle blink reflexes and skin conductance responses were assessed in 7 to 12 year old anxious children (N=21), non-anxious children at-risk for anxiety by virtue of parental anxiety disorder status (N=16) and non-anxious control children of non-anxious parents (N=13). Responses were elicited by 28 auditory startle stimuli presented prior to undertaking mild anxiogenic laboratory procedures. Results showed that group differences in startle reactivity differed as a function of children's age. Relative to control children for whom age had no effect, startle reflex magnitude in anticipation of anxiogenic procedures increased across the 7 to 12 years age range in children at-risk for anxiety disorders, whereas elevations in startle reactivity were already manifest from a younger age in children with anxiety disorders. These findings may suggest an underlying vulnerability that becomes manifest with development in offspring of anxious parents as the risk for anxiety disorders increases.     

Health condition of the Baltic grey seal (Halichoerus grypus) during two decades. Gynaecological health improvement but increased prevalence of colonic ulcers

Results obtained at postmortem examinations of 159 Baltic grey seals during the 20-year period 1977-1996 are presented. The investigation was initiated due to a serious reduction of the Baltic grey and ringed seal populations. Earlier, reduced reproductive ability with occlusions and stenoses of the uterus, as well as a disease complex in adult individuals of both sexes, was reported. The disease complex comprised lesions of claws, skull bone, intestine (colonic ulcers), kidneys (glomerulopathy, tubular cell proliferations), arteries (sclerosis) and adrenals (cortical hyperplasia, cortical adenomas). Besides occlusions and stenoses, tumours (leiomyomas) were common in the uterus. This report focuses on the results of a time-trend study covering the two decades 1977-1986 and 1987-1996. The prevalences (%) in the two decades of moderate to severe lesions of claws, intestine, arteries and adrenals are compared, as well as the prevalences of lesions of the female reproductive organs and rate of pregnancy. A similar comparison was made of animals born before 1980 and those born after 1979, in order to investigate a possible relation between the evident decrease in PCB and DDT pollution of the Baltic which occurred in the 1970s and seal health. A positive time trend respecting gynaecological health was confirmed, with a decreased prevalence of uterine obstructions, from 42 to 11%, and an increased prevalence of pregnancies, from 9 to 60%. The high incidence of uterine tumours (leiomyomas) seems to have decreased slowly (from 53 to 43%). Of special interest is the increased prevalence of colonic ulcers in young animals. The findings indicate that the food consumed by the Baltic seals may contain "new" or increased amounts of hitherto unidentified toxic factors which affect their immune system.     

A single peptide derived from the sequence common to polyoma small and middle T-antigen induces immunity against polyoma tumors

Polyoma virus, an oncogenic virus, fails to induce tumors in immunocompetent rodents due to T cell-dependent mechanisms. The target recognized by the immune system has been functionally defined as polyoma tumor-specific transplantation antigen (TSTA) and has been postulated to be related to the virus three early proteins small T (ST), middle T (MT), and large T (LT) antigens. We show here that immunization with a synthetic peptide corresponding to amino acids 162-176 of polyoma MT and ST was able to decrease tumor progression of polyoma tumors, but not of nonpolyoma tumors. This indicated that these amino acids constitute an epitope of the polyoma tumor-specific transplantation antigen.