Lower urinary tract symptoms in older adults undergoing hip arthroplasty: a feasibility study.

PURPOSE: We undertook a feasibility study to explore the prevalence of preoperative and postoperative lower urinary tract symptoms (LUTS) in older adults undergoing elective hip arthroplasty and to determine whether a larger prospective study was warranted. METHOD: Subjects awaiting elective hip arthroplasty were recruited preoperatively from an orthopedic office and preadmission clinic at 1 university-affiliated hospital. LUTS and related quality of life were measured prehospitalization and 6 weeks postoperatively using the American Urological Association Symptom Index and quality-of-life score. Postvoid residual urine and the 24-hour pad test were used to assess bladder emptying and continence status. RESULTS: Sixteen participants (9 males, 7 females, mean age 74 years) completed the study. Preoperatively, 15 participants reported at least 1 symptom and none had discussed these with a healthcare professional. The most common LUTS were nocturia, frequency, and urgency. Postoperatively, all reported symptoms, with 8 (53%) experiencing increased symptoms with a negative impact on quality of life for 3. Recruitment was a major barrier in conducting the study and would need to be taken into account in further studies of the topic. CONCLUSION: Despite recruitment issues, we suggest larger studies of LUTS in older adults undergoing surgery are warranted to further understand potential problems and risks in transition from hospital to home. Future studies should include identification of potential reasons for increased LUTS, including urinary tract infection.     

Differential etiology of posttraumatic stress disorder with conduct disorder and major depression in male veterans.

BACKGROUND: Epidemiologic studies reveal that posttraumatic stress disorder (PTSD) is highly comorbid with both conduct disorder and major depression in men. The genetic and environmental etiology of this comorbidity has not been examined. METHODS: Data were analyzed from 6744 middle-aged male-male monozygotic and dizygotic twins from the Vietnam Era Twin Registry. Conduct disorder, major depression, and PTSD were assessed via telephone interview using the Diagnostic Interview Schedule for the DSM-III-R in 1992. Structural equation modeling was used to estimate additive genetic, shared environmental, and individual-specific environmental effects common and specific to conduct disorder, major depression, and PTSD. RESULTS: The association between conduct disorder and PTSD was explained primarily by common shared environmental influences; these explained 10% (95% confidence interval: 6%-17%) of the variance in PTSD. The association between major depression and PTSD was largely explained by common genetic influences; these explained 19% (95% confidence interval: 11%-26%) of the variance in PTSD. CONCLUSIONS: Our findings suggest that different etiologic mechanisms explain the association of conduct disorder and major depression with PTSD in male veterans. If replicated in other populations, results suggest research aimed at identifying specific genetic and environmental factors that influence PTSD may benefit from starting with those that have been more consistently and strongly associated with major depression and conduct disorder.     

Complications Related to Dapsone Use for Pneumocystis Jirovecii Pneumonia Prophylaxis in Solid Organ Transplant Recipients

Dapsone, used for prevention of Pneumocystis jirovecii infections, has been reported to cause hemolytic anemia and methemoglobinemia; its tolerability in solid organ transplant recipients is not well described. We investigated dapsone-related adverse events in patients undergoing solid organ transplantation from 1999 to 2004. Transplant providers identified patients for the investigators who then reviewed the patients' hospital and outpatient records. Sixteen solid organ transplant recipients fit case definitions for dapsone-related hemolytic anemia (n = 11) or methemoglobinemia (n = 5). Median time from event to dapsone discontinuation was 15 days; all patients improved after drug discontinuation. G6PD enzyme activity was normal in all patients whose test results were available. Dapsone may be associated with hemolytic anemia or methemoglobinemia, even with normal G6PD levels. These events are often not promptly recognized, and drug discontinuation is delayed. Dapsone-related hemolytic anemia or methemoglobinemia should be considered in solid organ transplant recipients with unexplained anemia or hypoxia.     

Membrane Transporters in Drug Disposition

Many clinically used drugs and their metabolites as well as a variety of environmental toxins are organic cations at physiologic pH. Secretion in the renal proximal tubule constitutes a major pathway in the elimination of organic cations. In this report, the results of studies recently performed in this laboratory are presented. First, the molecular cloning of a novel splice variant of organic cation transporter from rat kidney (rOCTIA) is described. The functional characteristics of the transporter are discussed along with the implications of RNA splicing in enhancing transporter diversity. Second, the molecular cloning of the first human organic cation transporter (hOCTI) is described. Distinct interspecies differences in the tissue distribution and function of this transporter is presented. These studies have paved the way for elucidating molecular structure function relationships of organic cation transporters and for determining their physiologic role in drug absorption and elimination. The cloned transporters can be used in mammalian expression systems for screening candidate compounds identified during drug discovery and development and in the in vivo prediction of the pharmacokinetics of therapeutic agents.