Gastroesophageal Reflux,Motility Disorders,and Psychological Profiles in the Etiology of Globus Pharyngis

The aim of this study was to investigate the origin of globus pharyngis with particular reference to esophageal disorders such as gastroesophageal reflux disease (GERD), motility disorders, structural abnormalities, other gastrointestinal tract diseases, and psychological profile. Previous studies on this subject using 24-hour pH monitoring give conflicting results and are hampered by the high background prevalence of asymptomatic GERD in the normal Western population. The local Chinese population is known to have a very low background level of GERD and therefore is an ideal study population. Twenty-six patients with globus pharyngis underwent 24-hour ambulatory pH monitoring, esophageal manometry, and esophagogas-troduodenoscopy with lower esophageal biopsy. A control group of 20 patients presenting with non-ulcer dyspepsia was similarly investigated. Personality profiles of the globus pharyngis subjects and an appropriate control group were assessed. Eight of the globus pharyngis group (30.7%) had evidence of GERD, whereas only one of the controls (5%) demonstrated GERD on 24-hour esophageal pH monitoring (P < 0.05). The manometric and personality profile studies did not show significant differences between study and control groups. We concluded that the finding of GERD in patients with globus pharyngis is not a coincidental finding but that there is a true association between GERD and globus pharyngis.     

Ischemic necrosis of the entire femoral head and rapidly destructive hip disease: potential causative relationship

 Objective. Rapidly destructive hip disease (RDHD) is an uncommon disorder of the hip that has been considered a disease of unknown cause and distinct from ischemic necrosis of the femoral head. The objective of this study was to investigate ischemic necrosis of the femoral head as one potential cause of RDHD. Design and patients. In 600 patients who underwent MR imaging of the hip, 20 cases of ischemic necrosis involving the entire femoral head in 18 patients (3%) were retrospectively studied with routine radiography and MR imaging. All patients had surgically confirmed ischemic necrosis of the femoral head. Results and conclusions. All patients showed rapid destruction of the femoral head on routine radiography and MR imaging as compared with the gradual onset of clinical symptoms. Plain radiographs showed several bone fragments at the inferomedial aspect of the femoral head (75%), acetabular erosions (55%), eccentric depression at the lateral articular surface of the femoral head conforming to the adjacent acetabulum (35%), and mild osteoarthritis (15%). Bone sclerosis was often present at sites of impaction between the femoral head and the acetabulum. MR imaging showed marked distention of the joint capsule in all cases. In 14 of 20 cases, the contents of the joint space showed predominantly low or intermediate signal intensity on T1- and T2-weighted images. Ischemic necrosis involving the entire femoral head may represent one of the causes of RDHD.     

Dual-energy x-ray absorptiometry of the forearm: reproducibility and correlation with single-photon absorptiometry.

Although single-photon absorptiometry (SPA) has been the predominant tool used to assess bone mineral density (BMD) in the forearm, the development of dual-energy x-ray absorptiometry (DEXA) provides the benefits of greater source stability, reduced scanning time, and improved image resolution compared to SPA. In the present study we used the DEXA bone densitometer (Hologic, Inc., Waltham, MA) to (1) measure BMD in the one-third radius and ultradistal radius; (2) examine the reproducibility of these BMD measurements; and (3) compare the BMD at the one-third radius with SPA (SP2, Lunar Corp., Madison, WI). In 65 normal women (ages 22-74 years) we examined changes in the forearm DEXA BMD with age, revealing significant quadratic regression equations. The reproducibility of DEXA BMD (mean +/- SEM) in 7 normal subjects aged 22-50 years is 0.85 +/- 0.16% for the predominantly cortical one-third radius site and 0.97 +/- 0.15% for the more trabecular ultradistal site. The regression relationship between DEXA and SPA of the one-third radius in 26 subjects (ages 22-68 years) is DEXA BMD = 0.105 + 0.826 (SPA BMD); R = 0.97, R2 = 0.94, p less than 0.0001. Bone densitometry of the forearm using DEXA may be performed relatively rapidly, providing reproducibility and image resolution that are generally superior to those observed with SPA.     

Acquired cystic disease in chronically rejected renal transplants.

Acquired cystic disease has been documented to complicate most forms of chronic renal damage; it has only infrequently been described in transplanted kidneys. Five patients with noncystic ESRD and chronically rejected transplants in which acquired cystic disease arose are reported. The diagnosis of acquired cystic disease was established in examination of transplant nephrectomies from four patients and a core biopsy from the fifth. The allografts were in place from 44 to 80 months; three patients were treated with hemodialysis before the diagnosis of acquired cystic disease, whereas two received peritoneal dialysis. Three of the four patients evaluated had cysts in the native kidneys. Although papillary hyperplasia of lining epithelium was evident in four specimens, only one kidney was the site of neoplasms in the form of multiple small tubular adenomas. No malignant neoplasms were noted in this study or in the few similar previous ones; however, it is possible that chronically rejected transplanted kidneys may harbor neoplasms with the same malignant potential as those in acquired cystic disease in native kidneys.     

Effects of posts on dentin stress distribution in pulpless teeth.

A finite element analysis was carried out to study the roles of posts in reducing dentin stress in pulpless teeth. Two-dimensional plane strain models of the midlabiolingual section of a human maxillary central incisor were first analyzed. The results showed that the gold alloy post reduced maximal dentin stress by as much as 30%. However, the integrity of the dentin was compromised and the effects of the post were likely to be exaggerated in such models. In an effort to correct for these problems, plane stress models with side plates and axisymmetric models were analyzed. Posts were found to reduce maximal dentin stress by only 3% to 8% when the teeth were subjected to masticatory and traumatic loadings in these latter models. Although posts reduced maximal dentin stress by as much as 20% when the teeth were loaded vertically, teeth such as incisors and canines normally are not subjected to vertical loadings. Thus the reinforcement effects of posts seem to be doubtful in these teeth.     

Prostate and bone fibroblasts induce human prostate cancer growth in vivo: implications for bidirectional tumor-stromal cell interaction in prostate carcinoma growth and metastasis.

Prostate cancer selectively metastasizes to the axial skeleton to produce osteoblastic lesions, which suggests that bidirectional paracrine interactions exist between prostate cancer and bone cells. To evaluate the role of tumor-stromal cell interaction and stromal-specific growth factors in prostate cancer growth and dissemination, we coinoculated nontumorigenic human prostate cancer cells (LNCaP) and various tissue-specific fibroblasts subcutaneously in athymic mice. LNCaP tumors were induced most consistently by human bone fibroblasts (62%), followed by two prostate fibroblast cell lines (31% and 17%), but not by lung, kidney, or embryonic 3T3 fibroblasts. Carcinomas formed preferentially in male hosts, demonstrating in vivo androgen sensitivity. Immunohistochemical and biochemical techniques confirmed the human prostate component of these tumors and were paralleled by elevations in serum prostate specific antigen. In vitro mitogenic assays revealed a two-to three-fold bidirectional stimulation between LNCaP and bone or prostate fibroblast conditioned media, but not lung, kidney, or 3T3 fibroblast conditioned media. A novel method developed to deliver concentrated bone or prostate fibroblast conditioned media in vivo using a slowly absorbed matrix (gelfoam) also induced tumor formation, emphasizing the importance of fibroblast growth factors in LNCaP tumor formation. Northern analysis identified the stromal compartment as the primary source of extracellular matrix (collagen, fibronectin), while only LNCaP cells expressed transforming growth factor alpha. Although LNCaP and stromal cells express basic fibroblast growth factor (bFGF), the bidirectional paracrine-mediated mitogenic activity between these cells is not inhibited by anti-bFGF antibodies, suggesting that other undefined growth factors may be involved in stimulating LNCaP growth. These observations illustrate the importance of stromal-epithelial interaction in prostate tumor growth and suggest that extracellular matrix and paracrine-mediated growth factors play a role in prostate cancer growth and metastasis.     

Trend analysis of social and economic indicators of mammography use in Hawaii.

We examine the relationship between ethnicity and income as determinants of mammography use over a span of four years as a means of assessing community intervention impacts. The sample consisted of 1,447 women older than 34 years, living in Hawaii, who participated in the Behavioral Risk Factor Surveillance System (BRFSS). The percentage of women in the sample reporting a screening mammogram within the past two years was 31.4% in 1987, 54.1% in 1989, and 51.6% in 1990. Women of Hawaiian ancestry had the lowest percentage of mammogram use in the past two years (38.7%), while Japanese women had the highest percentage (49.8%). Results of logistic regression analysis indicate a significant increase in mammography use from 1987 to 1989 and no difference from 1989 to 1990. Findings also showed an association between age, income, and ethnicity with use in the past two years. Greater age, higher income, and Japanese origin, compared to Hawaiian, were all independently associated with increased odds of having had a mammogram in the past two years. We discuss results in terms of program evaluation and future research implications for community health surveys.     

Numbers and proportions of unmyelinated axons at cervical levels in the fasciculus gracilis of monkey and cat.

The present study is a quantitative analysis of the unmyelinated fiber population in the fasciculus gracilis of the second cervical segment of cat and monkey. We find that unmyelinated fibers represent 13.7% of the total fiber population in this pathway in the cat and 18.9% in the monkey (Macaca fascicularis). The existence of such large numbers of these axons suggests that there may be a sizeable ascending fine primary afferent pathway in the fasciculus gracilis in cat and monkey whose destination is presumably the dorsal column nuclei. These findings are of interest in regard to classic ideas that the afferent fibers in the dorsal columns are large myelinated fibers that convey fine discriminative information to the dorsal column nuclei.     

The epidemiology of urinary dysfunction in Chinese women

The epidemiology of urinary dysfunction in a Chinese population living in Hong Kong was investigated. Fifteen hundred ethnic Chinese women answered a telephone questionnaire including symptoms of urinary dysfunction, anthropometric measurements, obstetric history and place of birth. The relative predictive value of these factors was analyzed using logistic regression. The prevalence of urinary dysfunction was 13%. Ten percent reported stress incontinence, and 4% had urgency or urge incontinence. The strongest predictor was place of birth, with women born in mainland China having the highest prevalence of pure stress incontinence (OR 1.33, CI 1.1–1.6). For the symptoms of detrusor instability age was the strongest predictor, with women over 50 years being at greater risk (OR 2.8, CI 1.6–5.0). Contrary to earlier beliefs, urinary dysfunction in Chinese women is as common as in Caucasian women. Place of birth is the strongest predictor for pure stress incontinence, with women born in mainland China being at greater risk. This suggests that environmental factors in early life have a differential effect on the development of urinary incontinence. EDITORIAL COMMENT: Taiwan Chinese women have a comparable prevalence of urinary dysfunction with Hong Kong Chinese women. A survey representing a multistage sample of 82 678 women aged 18 years or older was conducted in the Taipei area from January to June 1993. A total of 818 cases were interviewed by trained students. One hundred and eighty-nine (23.1%) of the respondents reported having had some degree of incontinence in the preceding 12 months, 28 (3.4%) reporting regular incontinence. Most presented with stress urinary incontinence, whereas urge incontinence and mixed incontinence were more commonly seen in the elderly group (aged 60 years or older). The risk factors for urinary incontinence included age, number of vaginal deliveries (>3), number of abortions (>2) and maternal history of incontinence. Voiding symptoms (irritative or obstructive) and constipation were significantly more prevalent among respondents with incontinence than those without (P<0.001). This evidence also indicates that the long-held belief that Chinese women have a much lower prevalence of urinary dysfunction than western women has all but ended.