The globalization of capital, the welfare state, and old age policy.

A new political economy is shaping the lives of present and future generations of older people. The key change has been the move from the mass institutions that defined growing old in the period from 1945 through the late 1970s to the more individualized structures--privatized pensions, privatized health and social care--that increasingly inform the current period. The authors examine the role of international governmental organizations in promoting this trend, with examples drawn from the work of the World Bank, World Trade Organization, and Organization for Economic Cooperation and Development, and the relationship between international governmental organizations and the state. The article concludes with an assessment of the changes to citizenship that accompany globalization and the implications for political organization among older people themselves.     

t(12;17)(p13;q21) in early pre-B acute lymphoid leukemia.

Structural rearrangements involving the short arm of chromosome 12 occur in 10% of cases of childhood acute lymphoid leukemia. The translocation t(12;17)(p13;q21), an uncommon 12p abnormality, was identified in five of 2620 cases (0.2%) successfully karyotyped by the Pediatric Oncology Group or St Jude Children's Research Hospital. All five cases were classified as early pre-B; however, CD10 (common acute lymphoblastic leukemia antigen) was expressed at lower levels than other markers of B-cell lineage. Two cases also expressed the myeloid-associated antigen CD33. Leukemic cells were pseudodiploid in four cases, with an extra chromosome 21 in the fifth case. All of these patients achieved complete remission. Two relapsed during subsequent therapy, and three remain in continuous remission for greater than or equal to 20 months.     

Diagnosis of placenta previa during the third trimester: role of transperineal sonography.

Placenta previa can be difficult to diagnose with transabdominal sonography during the third trimester of pregnancy, because of difficulties in imaging the cervix late in pregnancy. Although transperineal sonography offers an additional view of the cervix, its value in the diagnosis of placenta previa has not been studied. Accordingly, we performed transperineal sonography on 164 patients who had had transabdominal scans that had shown placenta previa or had been inconclusive during the third trimester of pregnancy. Transabdominal sonograms had been inconclusive for placenta previa in 157 of these patients because the cervix was not visualized. The remaining seven patients had transabdominal scans that showed placenta previa. Transperineal sonography successfully visualized the internal surface of the cervix in all 164 patients, allowing determination of the presence or absence of placenta previa in all cases. Transperineal sonograms showed absence of placenta previa in 154 patients. At delivery, none of these patients had evidence of placenta previa. Transperineal sonography showed placenta previa in 10 patients. In nine of these patients, placenta previa was confirmed at delivery. The 10th patient did not have clinically significant placenta previa at delivery. Our study shows that transperineal sonography is a valuable technique to complement transabdominal sonography for detection of placenta previa during the third trimester of pregnancy. Use of transperineal sonography should be strongly considered when a definitive diagnosis regarding placenta previa is not possible by transabdominal sonography because the cervix is not visualized. In such cases, transperineal sonography will usually show the internal surface of the cervix without overlying placental tissue, allowing confident exclusion of placenta previa. Occasionally, however, transperineal sonography will show a placenta previa that was not seen with transabdominal sonography.     

Primary adenocarcinoma of the temporal bone. A case with 40-year follow-up

Adenomatous tumors of the temporal bone are rare neoplasms. This article records the 40-year course of a patient with adenocarcinoma of the temporal bone and reviews the literature pertinent to the biologic behavior, histologic appearance, prognosis, and treatment of this group of tumors.     

The effect of in vivo ethanol consumption on cyclic AMP and δ-opioid receptors in mouse striatum

In this study the effect of in vivo ethanol consumption on cyclic AMP (cAMP) and [

Full-size image

-Ala²,

Full-size image

-Leu⁵]enkephalin (DADLE) inhibition of forskolin-stimulated cAMP production was examined in mouse striatum. Effects of ethanol on striatal δ-opioid receptor (DOR) density and mRNA were also examined. Mice had unlimited access to 7% (v/v) ethanol alone or water for 1 or 7 days and were then sacrificed and striatum removed for analysis. There was no difference in basal cAMP formation between water and ethanol-treated mouse striatum following 7 day treatment, and a small, but statistically significant increase in basal cAMP in the ethanol group following 1 day treatment. Both 1 day and 7 day ethanol treatment did not significantly alter the percentage increase in cAMP following treatment with 10 μM forskolin. There was a significant effect of ethanol treatment on the maximum inhibitory effect of DADLE on forskolin-stimulated cAMP formation following both 1 and 7 day ethanol treatment. The DADLE IC₅₀ was unaffected by ethanol treatment. Saturation binding studies ([³H]Deltorphin II) indicated no effect of ethanol on B_max or K_d in striatum. Similarly, no difference between water and ethanol-treated was observed for DOR mRNA in striatum. These data indicate that ethanol consumption can alter opioid regulation of cAMP formation. However, this effect is not related to changes in any δ-opioid receptor parameters that were examined.     

High-intensity resistance training and postmenopausal bone loss: a meta-analysis

Introduction Conflicting evidence exists regarding the optimum exercise for postmenopausal bone loss. A systematic review and meta-analysis was undertaken to evaluate the effects of randomised controlled trials (RCTs) of progressive, high-intensity resistance training on bone mineral density (BMD) amongst postmenopausal women.Methods Structured electronic searching of multiple databases and hand-searching of key journals and reference lists was undertaken to locate relevant studies up to December 2004. Study quality and possible publication bias were assessed using recognised methods. Primary outcomes were absolute changes in BMD at the lumbar spine (LS), femoral neck (FN) and total hip (TH). A priori defined subgroup analyses included concurrent hormonal or antiresorptive therapy or calcium supplementation during the intervention. The weighted mean difference method (WMD) was used for combining study group estimates. Random or fixed effect models were applied according to study heterogeneity observed from the I ² statistic.Results At the LS, 14 RCT study groups were homogenous (I ²=25.2%) in demonstrating a significant increase (P=0.006) in BMD of 0.006 g/cm² (fixed effect; 95% CI 0.002–0.011) following high-intensity resistance training. In contrast, marked heterogeneity (I ²=88.2%) was apparent within 11 RCT study groups evaluating FN. For this comparison, a random effects model showed a positive change in FN BMD of 0.010 g/cm² (95% CI −0.002 to 0.021; P = 0.11). Subgroup analyses showed more anatomical variability of BMD responses to resistance training according to participants’ hormone therapy use. Treatment effects for study groups increasing all participants’ calcium intake showed significant positive BMD changes at TH (P=0.007). Methodological quality of all included studies was low, and a reporting bias towards studies with positive BMD outcomes was evident.Conclusions These findings are relevant to the nonpharmacological treatment of postmenopausal bone loss.     

Laparoscopic-guided biopsy for diagnosis of hepatic candidiasis.

Histopathological evaluation of infected tissue is critical in the diagnosis of hepatic candidiasis since cultures are unreliable. Percutaneous techniques are inaccurate because lesions often are small and multifocal, and open biopsy is not always well-tolerated in acutely ill patients. The authors investigated the feasibility of laparoscopically guided biopsy in patients suspected of having hepatic candidiasis. Preliminary results suggest that laparoscopically guided biopsy is highly accurate and less invasive than open biopsy.     

MELAS masquerading as a systemic vasculitis.

Mitochondrial encephalomyopathy, lactic acidosis, and stroke (MELAS) is a mitochondrial genetic disorder caused by a point mutation, resulting in the substitution of guanine for adenine at nucleotide 3243 (A3243G). It is a multisystem disorder with variable manifestations and typically presents between the first and third decades of life. It should be suspected if a patient exhibits stroke-like episodes before age 40, encephalopathy characterized by seizures, dementia, or both, and lactic acidosis, ragged-red fibers in muscle, or both.We present the case of a 26-year-old white man suspected with primary central nervous system vasculitis admitted to our facility with profound constipation from severe intestinal dysmotility. Although his gastrointestinal and neurologic symptoms did not meet criteria for a specific vasculitic syndrome, his symptoms and blood test abnormalities were concerning for such a process. MELAS was included in our differential diagnosis because his symptoms failed to fit a defined vasculitic process. When genetic testing documented the presence of the point mutation A3243G, his diagnosis was changed. This case illustrates the importance of considering a mitochondrial genetic disorder in the differential diagnosis of patients who present to Rheumatologists with suspected unusual or atypical vasculitic symptoms.     

Ultrastructural changes to the corneal endothelium due to benzalkonium chloride

Ten normal and 20 keratectomised corneas received hourly drops of vehicle with or without benzalkonium chloride (0.02% BAC or 0.01% BAC plus 0.1% disodium ethylenediaminetetraacetate) over the daylight hours of 2 days (18 applications). When applied to the intact cornea, BAC with or without Na2EDTA caused only slight clarification of the endothelial cytoplasm, whilst in a few mitochondria the cristae were displaced. In the keratectomised corneas receiving BAC, the majority of mitochondria of the central endothelial cells were pale and swollen or even disrupted. Many contained aggregations of membranous material either within the mitochondrion or at its outer membrane. The peripheral endothelium was much less affected than the central area of endothelium behind the keratectomy. These results suggest that BAC should not be administered to corneas in which the anterior epithelial barrier is incomplete.