LOWER LIMB AMPUTATION SECONDARY TO LARGE VESSEL INVOLVEMENT IN SCLERODERMA

A 34-year-old woman with scleroderma was admitted to hospitalwith pain and weakness of her left foot. She was subsequentlyshown to have developed a popliteal artery occlusion associatedwith progressive lower limb ischaemia. This culminated in below-kneeamputation. Marked intimal hyperplasia of the large vesselsin the leg was noted histologically. An increasing number of cases of large vessel involvement inscleroderma, a disease that primarily affects the microvasculature,has been reported. Scleroderma should be regarded as a rarecause of large vessel peripheral vascular disease. KEY WORDS: Scleroderma, Large vessel involvement, Intimal hyperplasia, Amputation, Peripheral vascular disease, Mononeuropathy     

Teratological, Neurochemical, and Postnatal Neurobehavioral Assessment of METASYSTOX-R, an Organophosphate Pesticide in the Rat

Teratological, Neurochemical, and Postnatal NeurobehavioralAssessment of METASYSTOX-R, an Organophosphate Pesticide inthe Rat. CLEMENS, G. R., HARTNAGEL, R. E., BARE, J. J., ANDTHYSSEN, J. H. (1990). Fundam. Appl. Toxicol. 14, 131–143.The purpose of this study was to assess the embryotoxic, fetotoxic,and teratogenic potential of METASYSTOX-R (MSR) in the rat.Furthermore, the study was designed to determine if maternallytoxic doses of MSR altered fetal brain acetylcholinesterase(AChE), compromised neonatal survival, growth, and development,or affected neurobehavioral development. Inseminated femalerats (45/dose group) received single daily oral doses of 0,0.5, 1.5, or 4.5 mg/kgofMSR from Days 6 to 15. Dose groups weresubdivided into three termination phases: Phase 1,5 femalesterminated on Day 16 of gestation; Phase II, 28 females terminatedon Day 20 of gestation; Phase III, 12 females terminated onDay 21 postpartum. MSR produced a dose-related reduction inmaternal plasma (30–72%), red blood cell (18-56%), andbrain (21-68%) cholinesterase (ChE) activity, when measuredon Day 16 of gestation. The high dose of MSR significantly (p 0.05) reduced food consumption, suppressed body weight gain,and produced tremors in 98% of the dams. MSR administered atmaternally toxic doses as high as 4.5 mg/kg was devoid of embryotoxic,fetotoxic, and teratogenic effects. Fetal brain AChE was notsubstantially different from control for any dose level in Day20 fetuses. Furthermore, neonatal survival, growth, and developmentwere unaffected and an extensive neurobehavioral testing schemedemonstrated no alteration of sensory or reflex functions, mazelearning ability, or open field activity for neonates.     

ADRENOCORTICAL ACTIVATION FOLLOWING STRESSFUL EXERCISE: FURTHER EVIDENCE FOR ATTENUATED FREE CORTISOL RESPONSES IN WOMEN USING ORAL CONTRACEPTIVES

Free cortisol, heart rate and affective responses to bicycle ergometry were studied in 31 women using oral contraceptives (OC) and 22 control women. While OC users and control women showed significant increases in both free cortisol and heart rate, OC users had significantly attenuated cortisol responses. Individual workload, peak heart rates and affective responses were similar in both groups. No effect of menstrual or pill cycle phase could be observed on the parameters studied. It is concluded that OC users are able to mount a significant free cortisol response to strenuous exercise but the response magnitude is lower than in women who do not use oestrogen-containing medication. Possible mechanisms and health implications are discussed briefly.     

Chronic sleep curtailment impairs the flexible implementation of task goals in new parents

Chronic sleep curtailment is a major concern for health in Western societies. Yet, research on potential consequences of long‐term sleep curtailment on cognitive functions is still scarce. The present study investigated the link between chronic sleep limitation and executive functions that enable adaptation to changing environmental demands, i.e. the ability to flexibly implement task goals. To address the effects of chronic sleep restriction under real‐life conditions, we considered a sample of adults who often suffer from reduced sleep durations over many months. One‐hundred and six new parents (infant’s age: 6–18 months) were assigned to a sleep‐curtailed group (<7 h of nighttime sleep) and a non‐sleep‐curtailed group (≥ 7 h of nighttime sleep), respectively, based on their self‐reported average nighttime sleep duration over the preceding 6 months. The ability to implement task goals was addressed applying a task‐switching paradigm in which participants randomly switched between two tasks. While the two groups did not differ with regard to overall performance level, number of nighttime awakenings, naps during the day, daytime sleepiness, mood, chronic stress level and subjectively perceived cognitive capability, sleep‐curtailed new parents showed higher costs for switching between tasks compared with repeating a task than non‐sleep‐curtailed new parents. This finding on the group level was further substantiated by a negative correlation between nighttime sleep duration and switch costs. With this study, we provide the first evidence for an impairment of the ability to flexibly implement task goals in chronically sleep‐deprived new parents and, thus, for a link between chronic sleep curtailment and executive functions.     

THE MALE BULBOURETHRAL SLING PROCEDURE FOR POST-RADICAL PROSTATECTOMY INCONTINENCE

Purpose

We evaluate the efficacy of the male bulbourethral sling procedure in the treatment of post-radical prostatectomy urinary incontinence.

Materials and Methods

We reviewed the records of 64 consecutive men with severe post-prostatectomy incontinence who underwent the male bulbourethral sling procedure at Northwestern Memorial Hospital and Stanford University Hospital. Preoperatively 50% of the patients were completely incontinent (diapers, clamps or condom catheter), and the remainder required a mean of 4.7 pads per day. Data were collected by chart review, patient interviews at followup appointments and telephone interviews. Median followup was 18.1 months (mean 22.4, range 6.5 to 53.8).

Results

Following a single sling procedure 36 patients (56%) became dry, and 5 (8%) were significantly improved. In 17 patients 23 retightening procedures were performed, which decreased the median followup to 16 months and increased the success rate to 75% (67% cured, 8% improved). The revision, erosion and infection rates were 27, 6 and 3%, respectively.

Conclusions

The male bulbourethral sling procedure is effective treatment for post-radical prostatectomy urinary incontinence. Patients who had received adjuvant radiation therapy demonstrated a lower continence rate than those who had not. Further followup is needed to assess long-term efficacy.