The effect of hormone replacement therapy on postmenopausal bone loss.

Eighty-four postmenopausal women who were randomly allocated to one of four groups, completed a 1 year follow-up. The first group (n = 20) received 0.625 mg/day conjugated estrogens cyclically (CE; 25 days/month). The second (n = 23) received 0.625 mg/day of CE continuously, and the third (n = 17) received 50 micrograms/day of transdermal 17 beta-estradiol cyclically (24 days/month). All these groups also received 2.5 mg of medroxiprogesterone acetate sequentially for the last 12 days of hormone replacement therapy, while the fourth group (n = 24) constituted a treatment-free control group. Dual photon absorptiometry was carried out before therapy and was repeated after 1 year. Serum calcium, phosphate and osteocalcine levels, and the urinary calcium/creatinine and hydroxyproline/creatinine ratios, were measured prior to treatment and 6 and 12 months thereafter. All treatment groups showed an increase in bone mineral content. This increase was higher in the continuous CE treatment group (4.4%, P less than 0.05) and in transdermal group (7.1%, P less than 0.01). Concomitant biochemical effects at 6 and 12 months, reduction in urine calcium and hydroxyproline, reduction in blood calcium, phosphate and osteocalcine, were compatible with the observed effects on bone mineral.     

Osteochondritis dissecans of the patella: 12 cases followed for 4 years

Osteochondritis dissecans of the patella in 9 patients (6 men, 3 women; mean age 19 years) was located in the median ridge and paramedial areas and was bilateral in 3 patients. All patients were initially treated conservatively with complete relief of symptoms in 5. In 7 patients fragments were excised and the crater was curetted and drilled. At follow-up after 4 (2-8) years, the patients had no restriction of activities and they had no pain.     

An endogenous modulator of N-methyl-D-aspartate receptor-coupled glycine receptors

Extensive washing of a membrane preparation from rat brain resulted in a progressive enhancement of strychnine-insensitive [3H]glycine binding, which was due to an increase in the number of binding sites with no changes in the apparent affinity of this radioligand, precluding an explanation based solely on the elimination of endogenous glycine. Moreover, after extensive washing a population of [3H]glycine binding sites with very high affinity for L-serine was observed in addition to the sites with low affinity for L-serine present in less extensively washed tissue. The observed changes in [3H]glycine binding were attributable to the elimination of a low molecular weight, heat-stable compound which was readily detected in the wash supernatant. Extensive washing also altered [3H](+)-5-methyl-10,11-dihydro-5H-dibenzo-[a,d]cyclohept-5,10-i min e maleate ([3H]MK-801) binding to N-methyl-D-aspartate (NMDA) receptor-associated channels, decreasing basal binding at equilibrium and producing slower association rates in the presence of either glycine or L-glutamate. Moreover, in well-washed membranes both glycine and glutamate enhanced [3H]MK-801 binding acting at high- and low-affinity sites. These findings suggest that the NMDA receptor complex can assume interconverting conformational states regulated by an endogenous substance(s).     

Experimental models of hypersensitivity pneumonitis.

Experimental models of hypersensitivity pneumonitis are important tools for the study of the pathogenesis of this disease. In this paper we review the characteristics of the main animal models developed until now. The HP models in rats seem to be particularly appropriate for studying pigeon fancier's disease and the HP induced by chemicals, as well as for studying mediators of acute lesions induced by immunocomplexes. However, the HP models developed in rats are of less value in the evaluation of other aspects of the pathogenesis of this clinical entity in humans. The murine models of HP offer several advantages: the ease and simplicity of intranasal administration, the ability to produce acute and subacute pulmonary lesions similar to those found in humans, the possibility of reproducing lesions similar to those of nonaffected exposed subjects and the possibility of pharmacologically modulating the process. Their disadvantages lie in the different pulmonary lymphocyte response and the difficulty in reproducing a model of chronic fibrosis. The HP models in rabbits are extraordinarily useful for evaluating the immunological mechanisms through which subjects repeatedly exposed to the antigen do not develop clinical manifestations. However, the rabbit has several immunological differences when compared to humans, and the effect of some immunomodulators in this animal is different. The models of HP in guinea-pigs have as advantages the ease in handling the animals, the possibility of pharmacological manipulation, and the ability to induce an acute phase that is very similar to that observed in humans. The drawback, however, is the low lymphocyte response and the striking eosinophilic reaction that contrast with the bronchoalveolar data found in HP in humans. In conclusion, there is no ideal model to reproduce all the findings observed in humans, suggesting that the experimental animal and the method of developing HP should be selected on the basis of concrete research aims.     

Assessing impairment in patients with panic disorder: the Sheehan Disability Scale

Summary The DSM-III-R incorporates both distress (symptoms) and disability (impairment) in the definition of a psychiatric disorder. In psychiatric research there is a wide array of instruments used to measure symptom severity, but a limited selection for the assessment of impairment. The psychometric properties of one such instrument, The Sheehan Disability Scale (Sheehan 1983), are evaluated in this paper. The data analyzed come from two studies of patients with panic disorder, the Cross National Collaborative Panic Study-Phase I and the Panic Depression Study. In this report both the alpha coefficients and factor analyses indicate that the reliability of the scale is acceptable. The factor structure of the items and the sensitivity to change of their composite demonstrate satisfactory construct validity. The criterion-related validity is substantiated by the significant relationship between symptomatology and impairment. These analyses were limited to patients with panic disorder. Further work is needed to evaluate the instrument in assessing patients with other disorders.     

Occurrence of Toxoplasma gondii antibodies in blood donors 1980-1990]

In 1980-1990 in the Strakonice district parallel serological examinations, using the Sabin-Feldman test (SFT) and complement fixation test (CFT), were made in 2,758 blood donors for the presence of antibodies against toxoplasmosis. The total number of examinations was 8,245. In the course of the mentioned time interval no significant increase or decrease of the serological prevalence occurred. During the first examination of blood donors the SFR antibodies (titre > or = 4) were detected in 45.4%, CFT (titre > or = 10) in 24.6% donors. 651 blood donors were examined four times or more frequently after 6-month intervals. 22.9% donors lacked antibodies (SFT and CFT) permanently, a rarely present low titre was recorded in another 22.9% donors, a repeated low titre in 43.6% and a repeatedly encountered medium or high titre in 10.6% of blood donors.     

A foodborne outbreak of group A streptococcal disease at a birthday party.

A severe foodborne outbreak of group A streptococcal disease (T28) affected 122/169 people (72%) who attended a church party or ate leftovers from the party. The median incubation time was 42 h. Muscular pain or weakness and fatigue usually preceded pharyngeal symptoms. Complications included otitis media with perforation, peritonsillitis requiring tonsillectomy, arthritis and pericarditis. A 45-year-old man died 36 h after he developed an influenza-like illness, and at necropsy there were histological signs of early streptococcal septicaemia. The strain produced erythrogenic exotoxins B and C. Streptococci were probably transmitted by sliced eggs on sandwiches. Laboratory experiments showed that there was an increment in viable count of streptococci with 6 logs after incubation in egg yolk for 24 h at room temperature. The unusually warm climate and flaws in food handling routines contributed to this large foodborne epidemic.