Exstrophy of the bladder. I. Long-term results in a series of 37 cases treated by ureterosigmoidostomy.

Of the 37 patients with exstrophy of the bladder in whom ureterosigmoidostomy was selected as the mainstay of treatment 4 died of causes related to the procedure. Faulty judgment and poor followup accounted for these deaths, which might well be preventable today. In 18 survivors, or approximately half of the entire series, the operation has held up well for many years, with no further surgical procedure being required for complications. In 12 patients, or approximately a third of the group, remedial operations for complications attributable to the ureterosigmoidostomy have been required but it was elected to retain this form of diversion. The long-term end result in these patients also remains acceptable. Combining these 2 groups 30 of 37 patients with ureterosigmoidostomy may be considered to have been eventually successful. However, in 7 of 37 patients the method was a frank failure, in that 4 patients died and 3 required substitution of another form of diversion. While all forms of treatment of exstrophy of the bladder leave much to be desired, results obtainable in today's setting lead us to recommend ureterosigmoidostomy as first choice in the management of this disorder. This recommendation is accompanied by the admonition that systematic followup is imperative so that if things do go badly from the clinical, laboratory or urographic viewpoint corrective measures can be done before renal deterioration occurs. The measures required may range from simple correction of electrolytes to conversion to an ileal loop.     

Peripheral pulmonary embolization from central pulmonary aneurysm.

A 59-year-old man underwent successful repair of a pulmonary arterial aneurysm because of peripheral pulmonary embolization. These lesions are relatively rare; and, to out knowledge, peripheral embolization from such an aneurysm has not been previously reported.     

Cross-sectional relationships of exercise and age to adiposity in 60,617 male runners

INTRODUCTION/PURPOSE: To assess in men whether exercise affects the estimated age-related increase in adiposity, and contrariwise, whether age affects the estimated exercise-related decrease in adiposity. METHODS: Cross-sectional analyses of 64,911 male runners who provided data on their body mass index (97.6%) and waist circumference (91.1%). RESULTS: Between 18 and 55 yr old, the decline in BMI with weekly distance run (slope +/- SE) was significantly greater in men 25-55 yr old than in younger men (slope +/- SE: -0.036 +/- 0.001 vs -0.020 +/- 0.002 kg x m(-2) per km x wk(-1)). Declines in waist circumference with distance were also significantly greater in older than younger men (P < 10(-9)), that is, the slopes decreased progressively from -0.035 +/- 0.004 cm per km x wk(-1) in 18- to 25-yr-old men to -0.097 +/- 0.003 cm per km x wk(-1) in 50- to 55-yr-old men). Increases in BMI with age were greater for men who ran under 16 km.wk(-1) than for relatively longer distance runners. Waist circumference increased with age at all running distances, but the increase diminished by running further (0.259 +/- 0.015 cm x yr(-1) if running <8 km x wk(-1) and 0.154 +/- 0.003 cm x yr(-1) for >16 km x wk(-1)). In men 50-85 yr old, BMI declined -0.038 +/- 0.001 kg x m(-2) per km x wk(-1) run when adjusted for age and declined -0.054 +/- 0.003 kg x m(-2) (increased 0.021 +/- 0.007 cm) per year of age when adjusted for running distance. Their waist circumference declined -0.096 +/- 0.002 cm per km x wk(-1) run when adjusted for age and increased 0.021 +/- 0.007 cm per year of age when adjusted for running distance. CONCLUSIONS: These data suggest that age and vigorous exercise interact with each other in affecting men's adiposity and are consistent with the proposition that vigorous physical activity must increase with age to prevent middle-age weight gain.     

Telomerase inhibition by retinoids precedes cytodifferentiation of leukemia cells and may contribute to terminal differentiation

Human promyelocytic leukemia HL60 cells display high telomerase activity, a phenotype related to their immortal status. All-trans retinoic acid (ATRA) is a clinically effective cytodifferentiating agent. To understand the mechanism underlying ATRA-induced cytodifferentiation, we did a kinetic analysis of the role of ATRA in inhibiting telomerase in HL60 cells. Our studies indicate that telomerase inhibition by ATRA occurred relatively early after treatment of HL60 cells due to a rapid decrease in hTERT gene expression. More importantly, however, we found through monitoring the expression of CD11b, a marker for granulocytic differentiation of HL60 cells, that down-regulation of telomerase preceded the differentiation of HL60 cells. These observations suggest that the hTERT gene may be a primary target of ATRA regulation of cellular differentiation and the antileukemia activity of ATRA may be mediated by its ability to induce the differentiation of the promyelocytic leukemia cells through down-regulation of the hTERT gene.     

Defining accelerometer thresholds for activity intensities in adolescent girls

PURPOSE: To derive a regression equation that estimates metabolic equivalent (MET) from accelerometer counts, and to define thresholds of accelerometer counts that can be used to delineate sedentary, light, moderate, and vigorous activity in adolescent girls. METHODS: Seventy-four healthy 8th grade girls, age 13 - 14 yr, were recruited from urban areas of Baltimore, MD, Minneapolis/St. Paul, MN, and Columbia, SC, to participate in the study. Accelerometer and oxygen consumption (.-)VO(2)) data for 10 activities that varied in intensity from sedentary (e.g., TV watching) to vigorous (e.g., running) were collected. While performing these activities, the girls wore two accelerometers, a heart rate monitor and a Cosmed K4b2 portable metabolic unit for measurement of (.-)VO(2). A random-coefficients model was used to estimate the relationship between accelerometer counts and (.-)VO(2). Activity thresholds were defined by minimizing the false positive and false negative classifications. RESULTS: The activities provided a wide range in (.-)VO(2) (3 - 36 mL x kg x min) with a correspondingly wide range in accelerometer counts (1- 3928 counts x 30 s). The regression line for MET score versus counts was MET = 2.01 +/- 0.00171 (counts x 30 s) (mixed model R = 0.84, SEE = 1.36). A threshold of 1500 counts x 30 s defined the lower end of the moderate intensity (approximately 4.6 METs) range of physical activity. That cutpoint distinguished between slow and brisk walking, and gave the lowest number of false positive and false negative classifications. The threshold ranges for sedentary, light, moderate, and vigorous physical activity were found to be 0 - 50, 51- 1499, 1500 - 2600, and >2600 counts x 30 s, respectively. CONCLUSION: The developed equation and these activity thresholds can be used for prediction of MET score from accelerometer counts and participation in various intensities of physical activity in adolescent girls.