Cadmium levels in maternal blood,fetal cord blood,and placental tissues of pregnant women who smoke

Previous studies have reported that cigarette smoking is a major source of exposure to cadmium (Cd). This study was carried out to determine the degree of exposure to Cd of pregnant women who smoke and to determine the disposition of the Cd in the maternal-fetoplacental unit. Our data reveal that pregnant women who smoke expose themselves and their placentas to levels of Cd higher than those to which they would normally be exposed. The percentage increase in Cd due to smoking was 32% in the placenta and 59% in maternal blood; these increases are statistically significant. The mean levels of Cd in maternal blood, cord blood, and placental tissues of pregnant women who smoked were all higher than the mean levels of Cd in the same tissues and blood of pregnant women who did not smoke. In addition, the levels of Cd in the maternal blood of smokers were significantly higher than levels of Cd in the cord blood of their infants; this relationship was not found in nonsmokers. On the basis of the Cd data on cord blood and placental tissues, the fetuses of pregnant women who smoke apparently receive very little additional exposure to Cd; however, this does not lessen concern for the fetus. The presently reported increase in exposure to Cd of pregnant women due to smoking must be viewed as undesirable because Cd has been shown to alter placental function in animals, and because Cd has no known biologic function.     

Extended field irradiation for cervical cancer based on surgical staging

Surgical staging was done in 355 patients with carcinoma of the cervix. Periaortic node biopsies, peritoneal cytology, and/or biopsy were obtained to determine the need of extended field irradiation. Forty-one patients received extended field irradiation. On review, 38 of these patients were shown to have cancer in the periaortic nodes or peritoneal cavity. Of these patients, 5 have survived longer than 5 years, 3 with metastatic cancer in the periaortic nodes and 2 in the peritoneal cavity. Irradiation to extended fields was 4500 rad or less for the first 17 patients. Since then 5100 rad has been delivered at the rate of 850 rad per week. The incidence of bowel complications was not excessive, utilizing a suture technique to exclude small bowel from the pelvis. Control of the cancer occurred in one patient with massive metastatic periaortic disease. A safe and effective dosage level for radiation therapy has been established with the described limited surgical exploration.     

Bipolar transurethral resection of prostate in saline: preliminary report on clinical efficacy and safety at 1 year

PURPOSE: To determine the clinical efficacy and safety profile of the bipolar transurethral resection in saline (TURIS) system (Olympus Japan) in the treatment of men with benign prostate hyperplasia (BPH). PATIENTS AND METHODS: We prospectively evaluated 45 patients with a mean age of 66 years (range 50-87 years) who had clinically significant BPH and were treated with transurethral resection of prostate using the TURIS system beginning December 2003. Acute retention of urine was the indication in 49% of the patients. Patients had outpatient follow-ups at 1, 3, 6, and 12 months. RESULTS: A mean weight of 25.3 g of prostatic tissue was resected in a mean time of 42 minutes (range 15-75 minutes). The mean decrease in hemoglobin and sodium was 1.4 g/dL and 2.2 mmol/L, respectively. The mean follow-up period was 10 months. The mean International Prostate Symptom Score decreased from 22.6 preoperatively to 6.5 at 12 months and the mean Q(max) increased from 6.5 to 18.3 mL/sec at 12 months. Postoperative hemorrhage was seen in 6.6% of the patients, including 2 primary hemorrhages that necessitated blood transfusion (4.4%). Other complications were prolonged catheterization (11.1%), urinary-tract infection (8.9%), and bulbar urethral stricture (4.4%). CONCLUSIONS: This pilot study indicates that TURIS is a safe and efficacious treatment for BPH at 1 year.     

Digestive Adaptation with Intestinal Reserve: A Neuroendocrine-Based Operation for Morbid Obesity

Background: Mechanical obstacles to food ingestion, nutrient-excluded segments and malabsorption are common strategies of bariatric surgery which are a potential cause of symptoms or complications. We describe an operation "Digestive Adaptation with Intestinal Reserve" (DAIR) that does not utilize these tools, aiming fundamentally at neuroendocrine changes. Methods: The operation includes sleeve gastrectomy, omentectomy and enterectomy, maintaining the initial 40 cm of jejunum and final 260 cm of ileum (keeping the bowel length at the lower limit for adaptation to normal). Jejunum is laterally anastomosed to ileum 80 cm proximal to the cecum. A gastroileostomy creates a transit bipartition (ileum and proximal bowel in transit). 55 patients are presented whose follow-up is >12 months (12-34 months). Fasting ghrelin and resistin, and postprandial GLP-1 and PYY were measured. Results: Mean BMI reduction was 4.8, 9.5, 15.4 and 20.1 kg/m² respectively at 1, 3, 6 and 12 months. Patients have early satiety and major improvement in pre-surgical co-morbidities, especially diabetes and hypertension. GLP-1 and PYY response to food ingestion were enhanced; fasting ghrelin and resistin were significantly reduced (P<0.05). Radiographic studies show nutrient transit through the pylorus and through the gastroileostomy. Early surgical complications (2 in 55 patients) resolved without sequelae. There were no signals of malabsorption, no deaths, and most patients present no symptoms at all. Conclusions: DAIR amplifies postprandial neuroendocrine response and provokes intense weight loss. DAIR reduces production of ghrelin and resistin and enables more nutrients to be absorbed distally enhancing GLP-1 and PYY secretion. Diabetes improved significantly without duodenal exclusion.     

Psychosocial adjustment of female partners of men with prostate cancer: a review of the literature

Advances in prostate cancer treatments since the 1990s have led to a growing proportion of patients living with the effects of the cancer. Various challenges face the man and his partner from the point of learning of the diagnosis: deciding among numerous diverse treatment options, dealing with side-effects of treatment and possibly facing the terminal phase of the illness. This invariably has an impact on the patient's family and, in view of the older age group of men usually affected, the experience of a partner is particularly relevant. A thorough review of the research literature reporting directly from partners of prostate cancer patients has not been undertaken previously. For this review, five databases were searched for the decade 1994-2005, during which most of the work in this field has been done. Very few evaluations of psychosocial interventions involving the partner were found, but there was a preponderance of qualitative studies involving small numbers of participants and quantitative surveys with little consistency in the measures used. The literature suggests that partners report more distress than patients, yet believe that patients are the more distressed, and the focus of concern of patients on their sexual function is not shared to an equal degree by their partners.     

Public health implications of smokeless tobacco use as a harm reduction strategy

Harm reduction strategies involve promoting a product that has adverse health consequences as a substitute for one that has more severe adverse health consequences. Smokeless tobacco low in nitrosamine content offers potential benefits in reducing smoking prevalence rates. Possible harm arises from the potential for such products to serve as a gateway to more harmful tobacco products, public misinterpretation of "less harmful" as "safe," distraction from the public health goal of tobacco elimination, and ethical issues involved in advising those marketing these harmful products. We offer a research agenda to provide a stronger basis for evaluating the risks and benefits of smokeless tobacco as a means of reducing the adverse health effects of tobacco.