Pubertal Onset and Sexual Orientation in an Adolescent National Probability Sample

Using 6-year longitudinal data from the National Longitudinal Survey of Adolescent Health (Add Health) and multiple measures of puberty as it occurs and of sexual orientation (romantic attraction, sexual identity), the present study attempted to replicate previous research which reported that homosexuals and heterosexuals differed in their age of pubertal onset. The study hypotheses were not confirmed for either males or females: on most pubertal measures, same-sex oriented groupings did not differ from heterosexuals. The only significant findings regarding homosexual males indicated that they were more likely to report having a later rather than an earlier onset of puberty, and the significant findings regarding homosexual females were contradictory—they tended to have an earlier onset of puberty. These findings are attributed to methodological improvements in the present study that reduced retrospective bias, used multiple indicators of sexual orientation and puberty timing, and assessed less eroticized measures of puberty.     

Metastatic renal cell carcinoma presenting as shoulder arthritis

Three patients with previously undiagnosed renal cell carcinoma presented with complaints of shoulder pain secondary to tumor metastases involving the clavicle or upper humerus. In two patients, bone scintigraphy and/or gallium scintigraphy demonstrated the primary renal lesion. One patient had been treated with anti-inflammatory drugs and intra-articular steroid injections for presumed arthritis before the cause of the symptoms was recognized. Review of the literature reveals that renal cell carcinoma frequently metastasizes to bones of the shoulder girdle, and that presenting complaints may relate to osseous metastases. Careful evaluation should be carried out before patients with shoulder pain are treated for presumed arthritis.     

Hypophosphorylation of aqueous humor sCD44 and primary open-angle glaucoma

PURPOSE: The ectodomain of CD44, the principal receptor for hyaluronic acid (HA), is shed as a 32-kDa fragment-soluble CD44 (sCD44)-which is cytotoxic to trabecular meshwork (TM) cells and retinal ganglion cells (RGCs) in culture. The purpose of this study was to characterize sCD44 further by determining the phosphorylation of aqueous humor sCD44 in normal and primary open-angle glaucoma (POAG). METHODS: Aqueous humor samples of patients were subjected to CD44 enzyme-linked immunosorbent assay (ELISA) and two-dimensional (2-D) polyacrylamide gel electrophoresis, followed by Western blot analysis with anti-CD44, anti-serine/threonine, and anti-tyrosine phosphospecific antibodies, to determine sCD44 concentration, isoelectric point (pI), and phosphorylation, respectively. The bioactivity of hypophosphorylated sCD44 was tested in cell culture and HA affinity columns. RESULTS: Two-dimensional Western blot analysis revealed that the representative pI of the 32-kDa sCD44 was 6.96 +/- 0.07 in POAG versus 6.38 +/- 0.08 in normal (P < 0.0004). Enzymatic dephosphorylation of sCD44 resulted in a basic shift in the pI. The normal aqueous humor sCD44 was positive for serine-threonine phosphorylation; however, POAG sCD44 was hypophosphorylated. Hypophosphorylated sCD44 was more toxic to TM and RGC cells than standard sCD44, and hypophosphorylated sCD44 had decreased affinity to HA, particularly with increased pressure. CONCLUSIONS: POAG aqueous is characterized by posttranslational change in the pI of sCD44 and hypophosphorylation, which clearly distinguished POAG from normal aqueous humor. The high toxicity and low HA-binding affinity of hypophosphorylated sCD44 may represent specific pathophysiologic features of the POAG disease process.     

Visual field progression outcomes in glaucoma subtypes

Purpose: To determine whether glaucoma subtype is an independent risk factor for visual field (VF) progression. Methods: We reviewed the charts of glaucoma suspects and glaucoma patients seen in a referral practice between 1999 and 2009. Automated pointwise linear regression analysis determined the rates of VF change. A progression endpoint was determined when two or more adjacent test locations in the same hemifield showed a threshold sensitivity decline at a rate of ≥1.0 dB/year with p < 0.01. Results: We included 841 eyes (841 patients; mean age, 64.1 ± 12.6 years; mean number of VF tests, 10.8 ± 2.8; mean follow‐up, 6.4 ± 1.7 years). The glaucomatous group consisted of angle‐closure glaucoma (76 eyes), juvenile primary open‐angle glaucoma (37 eyes), normal‐tension glaucoma (81 eyes), pigmentary glaucoma (34 eyes), primary open‐angle glaucoma (275 eyes) and exfoliative glaucoma (XFG, 84 eyes). Normal‐tension glaucoma eyes were more likely to present with beta‐zone parapapillary atrophy and disc haemorrhage (p < 0.01). Exfoliative glaucoma eyes had the fastest rates of global VF change (?0.65 dB/year), as well as the highest mean, fluctuation, and peak intraocular pressure during follow‐up (16.5, 3.0 and 22.0 mmHg, respectively) and reached a progression endpoint more frequently (40%). After adjusting for all covariates, including the glaucoma phenotype, there was no difference among groups regarding global rates of VF change and the risk of reaching a progression endpoint. Conclusions: Despite different clinical features, epidemiology and genetics, glaucoma phenotype is not an independent risk factor for VF progression. Rather, variations in well‐known, reported risk factors remain important disease parameters that affect progression.     

Overnight urethral stenting after tubularized incised plate urethroplasty for distal hypospadias

Objectives  

The duration of urethral stenting after tubularized incised plate (TIP) urethroplasty for hypospadias varies among surgeons. Typically the catheter is left for up to 7 days with the goal of minimizing post-operative complications. We describe our experience with overnight stenting for distal TIP hypospadias repair.