Haemodynamic Effects of Low Doses of Female Sex Steroids

Summary: Haemodynamic changes were monitored serially in 3 groups of healthy young women taking (i) a combined oestrogen-gestagen oral contraceptive containing a low dose of oestrogen, (ii) an oestrogen alone and (iii) a gestagen alone. Similar significant increases in plasma volume occurred in those women taking the combined preparation and in those taking the oestrogen. A small but significant decrease in forearm blood flow occurred in subjects taking the combined oral contraceptive. Cardiac output, blood pressure, heart rate and hand blood flow did not alter significantly in any of the 3 groups of subjects, while body weight increased in the subjects taking gestagen alone.
It is concluded that the combined oestrogen-gestagen oral contraceptives containing 50 μg. of oestrogen result in minimal haemodynamic side effects, and hence are safer than the older combined preparations containing a higher dose of oestrogen. The increase in plasma volume observed was due to oestrogen rather than gestagen. No additional information was obtained concerning the site of sex steroid action in the cardio-vascular system.     

Minimizing gang violence in the emergency department.

Street gang members are frequently injured, and the violence of their subculture may follow them from the streets into the emergency department. We present four cases in which in-hospital gang violence occurred or was prevented. To decrease the risk of injury from gang-related violence within the hospital, we offer guidelines for patient care and health care provider safety. Emphasis is on education, awareness, and early hospital security involvement.     

Ethnic patterns in drug abuse treatment utilization

This study describes utilization of drug abuse treatment and related perceptions among African American, Hispanic, and Anglo drug-using arrestees in Los Angeles. The study extends prior research by, first, describing ethnic variation in treatment utilization through analyses that control for nonethnic demographic factors and by, second, exploring the degree to which ethnicity is related to two predisposing factors (attitude toward treatment and perceived need) and two enabling factors (perceived cost and availability). After nonethnic demographic factors and past drug dependence are controlled, African American and Hispanic drug users in Los Angeles are less likely to report having been in drug abuse treatment. Hispanic drug users are more likely than Anglos to say that they have not sought treatment because they do not need it. African American drug users are more likely than Anglos to hold unfavorable views of treatment. Data used in this paper were collected under National Institute of Justice (NIJ) contracts 88-IJ-CX-K005, 89-IJ-CX-R007, and 89-IJ-R-007. Data analysis and report preparation were supported by NIJ grant 90-IJ-CX-0044 and the National Institute on Drug Abuse Grant K02 DA00146.     

Childhood Subacute Cutaneous Lupus Erythematosus Associated with Homozygous Complement 2 Deficiency

Abstract: We describe a 9-year-old boy with an Ro-positive, subacute, cutaneous lupus rash associated with homozygous C2 deficiency. His response to a mild topical steroid and sunscreen was excellent. Hereditary complement deficiency and its association with childhood lupus erythematosus are discussed.     

Patterns of perception of health in cardiac patients

Thirty-seven patients hospitalized for cardiac disorders were classified by cluster analysis in four groups based on their patterns of perception of health during the first year of recovery. Striking differences were found in the four patterns obtained. The groups were compared for variables of demographic background, physical health, and psychological state. Significant differences were found between clusters in pre- and post-hospitalization employment, alcoholism, state anxiety in the CCU and ICU, and number of days in CCU. No differences were found for measures of physical health.     

Trends in the treatment of acute myeloid leukaemia in the elderly

INTRODUCTION: Acute myeloid leukaemia (AML) is the most common type of leukaemia among adults in the US. However, data on longitudinal treatment patterns and outcomes associated with AML and its relapse are sparse, particularly among the elderly. This study documents changes in treatment patterns and outcomes among elderly AML patients over the past decade. METHODS: Using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we retrospectively evaluated trends in mortality, treatment patterns, healthcare resource utilisation and Medicare payments associated with AML and its relapse among Medicare beneficiaries > or =65 years of age who were initially diagnosed with AML in a SEER registry between 1991 and 1999. Chemotherapy was ascertained from examination of inpatient and outpatient bills. AML relapse and retreatment were identified using a validated algorithm. Costs of care were based on total Medicare payments. RESULTS: A total of 3439 elderly patients with AML were identified. Median survival across all study patients was 2.4 months (mean +/- SD 5.6 +/- 6.8 months), with medians of 3.9, 2.2 and 1.4 months for patients 65-74 years of age, 75-84 years of age and > or =85 years of age, respectively. Fewer than 7% of patients were alive at 2 years, and there was very little variation during the decade of our analysis. Costs and overall healthcare utilisation patterns also changed very little, with the exception of those relating to hospice use and chemotherapy. Hospice use more than doubled during the decade (from 12% to 29% among patients diagnosed in 1991 and 1999, respectively; p < 0.0001), mostly among the oldest patients. Administration of chemotherapy also increased from 29% of patients diagnosed in 1991 to 38% of patients diagnosed in 1999 (p = 0.014), with the increase being seen mostly among younger patients and those treated in teaching hospitals. Average total costs (+/- SD) were US$51,888 +/- $54,825 and declined by age as a result of lower survival. A total of 192 patients (16% of treated patients) relapsed and received retreatment with chemotherapy. These patients survived a median 18 months, with a median duration of remission of 8 months, and average total costs three times higher than the overall sample. CONCLUSIONS: The high early mortality and costs associated with AML have not changed significantly over the past decade. However, treatment patterns appear to be changing, with increasing use of chemotherapy and hospice care. The ongoing introduction of new treatments for AML in the elderly is likely to further impact treatment patterns, and may change the economic burden of the disease. Our findings can be used as a baseline against which the benefits of new therapies can be compared.     

Coronal oblique turbo STIR imaging of the sacrum and sacroiliac joints at routine MR imaging of the lumbar spine

The objective of the study was to evaluate the clinical impact of coronal oblique imaging of the lumbrosacral junction and the sacrum at initial presentation for MR imaging of the lumbar spine in patients presenting with low back pain or sciatic pain. Two hundred and sixty consecutive patients attending for MRI of the lumbar spine underwent simultaneous coronal oblique turbo short tau inversion recovery (STIR; TR 2500, TE 40, TI 150, echo train length 7, number of scan acquisitions 2) imaging of the sacrum and the sacroiliac joints with a field of view of 30-cm and 3-mm slices (acquisition time 3 min and 20 s). Images were reviewed by two experienced radiologists to determine the cause of back pain, with and without images of the sacrum and sacroiliac joints. The added value of the additional sequence was assessed. Correlation was made with surgery, response to nerve root injection or clinical follow-up at 3 months. Subgroup analysis was performed to determine if patient stratification according to sex or symptoms would be useful. In total, in 19 of 260 patients (7.3%), abnormalities were identified at coronal STIR imaging. In 7 of 260 patients (2.7%), pathology was identified in the sacrum thought to account for back pain, altering the diagnosis made on the standard sequences. These diagnoses were sacroiliitis (n=2), sacral stress fracture (n=1), degenerative sacroiliac joints (n=1), degenerative accessory articulation between the lumbar spine and the sacrum (n=1), Tarlov cyst of nerve root (n=1) and retroverted uterus causing sciatic pain (n=1). Patient stratification according to sex or the presence or absence of sciatic symptoms was not useful in predicting the added benefit of the additional sequence. Routine coronal STIR imaging of the sacrum as part of lumbar spine MRI improves assessment of patients presenting with low back pain or sciatica in only a small number of patients.     

Mice lacking dopamine D2 and D3 receptors exhibit differential activation of prefrontal cortical neurons during tasks requiring attention

Mice lacking dopamine D2 and D3 receptors and wildtype littermates were tested in a two-choice perceptual discrimination test that is dependent upon optimal functioning of the prefrontal cortex. Both mutants showed no deficits in attending to the perceptual stimuli or in shifting attention between stimulus dimensions. However, the performance of both mutants differed from the wildtype in different test phases. D2 mutants exhibited significant impairment in the first compound discrimination, indicating deficits in the initial acquisition of the task-governing rules. In contrast, D3 mutants performed significantly better in a set-shifting phase that required reversal learning. The higher response accuracy of D3 mutants was also accompanied by significantly increased response latency. A stereological assessment of test-induced expression of the c-fos gene in neurons of the anterior cingulate and prelimbic/infralimbic cortices revealed highest activation in D3 mutants, intermediate activation in wildtype and lowest activation in D2 mutants, indicating that response accuracy in the cognitive test correlates with the magnitude of prefrontal cortical activation regardless of which test phases revealed different performances. The study illustrates that dopamine differentially modulates prefrontal cortical activity during tasks requiring attention depending upon the type of D2-like receptor that is activated.     

Effects of endoscopic forehead/midface-lift on lower eyelid tension

OBJECTIVE: To evaluate and quantify the increase in lower eyelid tension (stress) after endoscopic forehead/midface-lift in a cohort of patients with normal lower eyelid function preoperatively. METHODS: A prospective nonrandomized study was conducted at a private facial plastic surgery practice and ambulatory surgical center on 22 patients who underwent subperiosteal endoscopic forehead/midface-lift from October 2000 to June 2002. Patients were evaluated preoperatively, 4 to 6 months postoperatively, and approximately 12 months postoperatively. RESULTS: Compared with preoperative lower eyelid tension, there was a 4- to 5-fold increase in lower eyelid tension at 3 and 5 mm of distraction immediately after the operation. Four to 6 months after the operation, lower eyelid tension decreased but was still 2 to 3 times that of preoperative values. Twelve-month measurements for the 15 patients who remained in the study (the other 7 patients were lost to follow-up or refused to have measurements taken) showed that lower eyelid tension was 1.7 to 1.9 times preoperative values. CONCLUSIONS: Our results show that lower eyelid tension increases following endoscopic forehead/midface-lift and that this increased tension is long lasting and quantifiable 12 months after surgery.