Exercise and older adults

The benefits of regular physical activity in older persons are numerous and well established. Regular physical activity in older adults is associated with an overall improvement in health, functional capacity, quality of life, and independence. Many questions arise for healthcare providers regarding an older person’s ability and motivation to be physically active. The healthcare provider has a unique opportunity to assess the older client’s incentives, preferences, and abilities for physical activities, as well as to prescribe a safe, appropriate, and enjoyable exercise plan. The exercise precription can be simple yet thorough enough to ensure benefits in an older person’s health and functional capacity.     

Engineering angiogenesis following spinal cord injury: a coculture of neural progenitor and endothelial cells in a degradable polymer implant leads to an increase in vessel density and formation of the blood–spinal cord barrier

Angiogenesis precedes recovery following spinal cord injury and its extent correlates with neural regeneration, suggesting that angiogenesis may play a role in repair. An important precondition for studying the role of angiogenesis is the ability to induce it in a controlled manner. Previously, we showed that a coculture of endothelial cells (ECs) and neural progenitor cells (NPCs) promoted the formation of stable tubes in vitro and stable, functional vascular networks in vivo in a subcutaneous model. We sought to test whether a similar coculture would lead to the formation of stable functional vessels in the spinal cord following injury. We created microvascular networks in a biodegradable two-component implant system and tested the ability of the coculture or controls (lesion control, implant alone, implant + ECs or implant + NPCs) to promote angiogenesis in a rat hemisection model of spinal cord injury. The coculture implant led to a fourfold increase in functional vessels compared with the lesion control, implant alone or implant + NPCs groups and a twofold increase in functional vessels over the implant + ECs group. Furthermore, half of the vessels in the coculture implant exhibited positive staining for the endothelial barrier antigen, a marker for the formation of the blood–spinal cord barrier. No other groups have shown positive staining for the blood–spinal cord barrier in the injury epicenter. This work provides a novel method to induce angiogenesis following spinal cord injury and a foundation for studying its role in repair.     

Absorbable staples in continent ileal urinary pouch

Continent ileal urinary reservoirs were created in dogs to study absorbable surgical staples. Within each pouch, certain controlled observations were possible. The staples and chemically similar polyglactin absorbable sutures caused almost identical tissue reactions. The staples outlasted the sutures, probably because of greater size. Inverted and everted staple closures worked equally well. It appears feasible to consider clinical urinary diversion with absorbable staples, a time-saving method.     

Fungal keratitis in contact lens wearers

In a retrospective review from 1972 through 1987 of patients with microbial keratitis, fungal infection occurred in four (4%) of 90 cosmetic or aphakic contact lens wearers and in four (27%) of 15 patients using a therapeutic soft contact lens. Predisposing factors included improper lens care by the refractive lens wearers and a chronic epithelial defect with topical corticosteroid use among the therapeutic lens wearers. The responsible organisms in the refractive lens group were Fusarium solani (two patients) and Cephalosporium and Paecilomyces (one patient each), and in the therapeutic lens group Candida (three patients) and Aspergillus (one patient). Filamentous fungi were more likely to be associated with cosmetic or aphakic lens wear, whereas yeasts were more frequently found with therapeutic lens use.     

Nutritional Status Outcomes for Children: Ethnic, Cultural, and Environmental Contexts

The objective of this literature review was to explore the relationship between nutritional status outcomes among ethnically diverse children and cultural and environmental contexts. Articles from the literature on anthropometric/body composition measures, diet, and physiologic outcomes among ethnically diverse children were identified through on-line literature searches and references from articles reviewed. These studies were critically reviewed and selected if they reported findings resulting from use of accepted methodologies. Explanations consistent with evaluation of results from the studies and reports were developed by synthesis of the findings. Children from underserved, ethnically diverse population groups were at increased risk for obesity, increased serum lipid levels, and dietary consumption patterns that do not meet the Dietary Guidelines for Americans. More than 80% of all US children consume more than the recommended amount of total fat and saturated fat. These factors, which were noted during childhood, may track into adolescence, placing these children at increased risk for the early onset of chronic diseases such as non-insulin-dependent diabetes mellitus, cardiovascular disease, hypertension, and some forms of cancer. Although federally funded food assistance programs are changing rapidly, currently they provide foods that, when eaten as recommended, exceed the Dietary Guidelines for these children. Future interventions to improve the health and nutritional status of our nation's children, especially those from underserved, ethnically diverse groups, should be culturally appropriate and implemented at the levels of individuals, families, and communities. J Am Diet Assoc. 1996; 96:891-900,903.     

Pelvic allograft. A case report with a follow-up evaluation of 5.5 years

A 23-year-old man with a large chondrosarcoma of the right bony pelvis was successfully treated by limb-saving internal hemipelvectomy and anatomic reconstruction of the pelvis by a pelvic osteoarticular allograft including the acetabulum. Optimum anatomic fit was achieved at the hip joint as well as at the iliac and pubic host-graft junctions, which were fixed with plates and screws. This reconstruction restored stability, leg length, hip motion, and cosmesis. Five and one-half years postoperatively, the patient remained asymptomatic with good functional and roentgenographic results.     

Telephone vs Face-to-Face Interviews for Quantitative Food Frequency Assessment

Objective To develop and test a quantitative food frequency method for administration by telephone.Design A comparison study of telephone and face-to-face interviews was conducted among a representative sample of the five major ethnic groups in Oahu, Hawaii. Two interviews were administered 4 to 6 months apart by trained interviewers using identical questionnaires and color photographs of food items showing three different portion sizes. The order of the interviewing methods was randomly assigned. The questionnaire included 115 food items selected to estimate 80% or more of usual dietary intakes. Frequencies and quantities of each item consumed during the past year were obtained.Subjects/setting Subjects were recruited from the Health Surveillance Program of the Hawaii State Department of Health and consisted of 167 men and 158 women, aged 45 to 74 years, who provided a telephone number. Eighty percent of the face-to-face interviews were conducted in the subjects’ homes and 20% were conducted at the workplace or the University of Hawaii Cancer Research Center, if requested.Statistical analyses The paired t test was used to compare the mean daily intakes obtained by the telephone and face-to-face methods. Agreement was measured by the intraclass correlation coefficient (ICC), Pearson correlation coefficient, and weighted κ statistic.Results The means of energy and each nutrient were slightly higher in the first interview than the second, regardless of the interviewing method. Because of close correspondence among all 3 statistical measures of agreement, only the ICCs are reported. The ICCs ranged from .61 for protein and vitamin A to .69 for dietary cholesterol among men, and from .61 for vitamin C to .74 for saturated fat among women. Agreement was not significantly affected by age, gender, ethnicity, order of interview, or educational level.Applications Telephone interviews to obtain quantitative food frequencies are cost-efficient methods for estimating usual dietary intakes among persons in widely scattered geographic areas. Photographs of the foods in 3 portion sizes mailed in advance help the respondents estimate amounts eaten. J Am Diet Assoc. 1998;98:44-48.     

Rectal Bleeding: A Rare Complication of Abdominal Pregnancy

EDITORIAL COMMENT: We accepted this case report for publication not only because of its rare anecdotal interest, which is considerable, but also since it will warn readers that rectal bleeding in pregnancy may result from an abdominal pregnancy. It is strange that the ultrasonograph seems not to have identified the calcification as a fetus although we are not told that the latter was macerated or misshapen. The editor has never seen or heard of an ectopic pregnancy causing rectal erosion and bleeding although he has reported a primary abdominal pregnancy in which the placenta was implanted on the peritoneum of the pouch of Douglas posteriorly (A); this woman presented at 23 weeks' gestation when retroplacental haemorrhage resulted in a haematoma that bulged into the vagina causing acute urinary retention. One wonders why the placenta did not erode the anterior rectal wall in this more advanced case of primary placental implantment in the pouch of Douglas.
Summary: A rare case of abdominal pregnancy, causing massive rectal bleeding due to invasion of the rectal wall by the placenta, is reported.