The Talking Sex Project: descriptions of the study population and correlates of sexual practices at baseline.

The Talking Sex Project is an HIV risk reduction education project for gay and bisexual men. It was developed to evaluate two types of small discussion groups using a randomized control study design. This paper reports on the baseline measures of knowledge, attitudes and sexual practices. The 612 subjects had a mean age of 32 years, were all English speaking and were relatively highly educated. Bivariate analyses found that younger men, those in a relationship, those reporting bisexual activity and those with higher levels of substance use were significantly more likely to have unprotected anal intercourse. While overall knowledge was not associated with sexual behaviour, a significant relationship was found with knowledge of risk of anal sex. Attitudes, in particular, the belief in the efficacy of condoms and the enjoyment of safer sex were found to have the strongest associations with protected anal intercourse. The paper provides an understanding of some of the factors which may be important to behaviour change and clues for the targeting of programs.     

Frequency of certain urgent eye problems in an emergency room in Massachusetts.

The frequency and cost of emergency room care for certain ocular problems was surveyed. Superficial eye problems accounted for 2.67 percent of patients reporting to the emergency room, while 0.23 percent reported for penetrating injuries. Of the conditions surveyed, conjunctivitis was the most commonly presenting diagnosis. Abrasions and superficial foreign bodies were the next most common presentations. Together these three diagnoses accounted for nearly 75 percent of all superficial eye problems seen in the emergency room. The cost of each emergency room visit averaged $132. This study has implications for health care managers and for legislatures contemplating expanding the scope of optometric practice.     

Five root canals in a mandibular first molar

Abstract Endodontic therapy was performed in a mandibular first molar with 5 root canals, 3 of which were located in 3 distal roots. The existence of 3 distal root canals was assumed after careful reading of radiographs. Two of the distal root canals were close to one another and located buccally to the midline. The 3rd was remote, located lingually. The 2 mesial root canals were found in their normal locations. This case demonstrates a rare anatomical configuration, and joins with recent reports in the emphasis of the existence of such configurations in mandibular first molars.     

Endoluminal sonography of the urinary tract: preliminary observations

Endoluminal sonography of the urinary tract was performed by using endoluminal ultrasound transducers contained within 2-mm-diameter catheters. The catheters were inserted into the urinary bladder via the urethra and advanced into the ureters and renal pelvis under cystoscopic control; then, cross-sectional images of the bladder, ureters, and renal pelvis were obtained. Two dogs and seven human patients were studied. In one dog, a 4.5-mm pseudopolyp, which was surgically created in the bladder wall, was successfully imaged; in the other, stones 2 mm or larger inserted into the bladder were identified. Of the seven patients, sonography showed stones embedded in the renal parenchyma (one patient) and the mucosa of the distal ureter (one patient). These were ultimately confirmed by their eventual removal. In a third, sonography showed a tumor of the distal ureter and identified the depth of the tumor. This was confirmed by biopsy. In a fourth, sonography clearly showed a crossing vessel as the cause for narrowing of the proximal ureter. In a fifth, sonography showed that the cause of a ureteral stricture was idiopathic. In the last two cases, sonography did not reveal a cause for hematuria. In these last three cases, negative sonographic results were confirmed by direct ureteroscopic examinations and follow-up studies. Our observations based on this limited study suggest that endoluminal sonography is a useful procedure for diagnosing diseases of the urinary tract. Further study is warranted.     

STD and HIV screening in general practice: a survey related to termination of pregnancy in south Thames.

It has been recommended that screening for sexually transmitted disease (STDs) be carried out at the time of termination of pregnancy to allow prevention of post-abortion infection. Screening offers the opportunity to treat an infected woman and prevent serious complications following the termination procedure. Our findings indicate that general practitioners (GPs) in South Thames did not routinely carry out screening and few realized it took place at referral centres.     

The pharmacokinetics of racemic verapamil in patients with impaired renal function

The pharmacokinetics of verapamil were studied in patients with renal failure who were undergoing maintenance hemodialysis and in normal subjects after an IV infusion of 10 mg and a single oral dose of 120 mg. Plasma levels of verapamil and its active metabolite, norverapamil, were analyzed by a sensitive and specific HPLC procedure. Severe renal failure requiring hemodialysis did not change the time course of verapamil and norverapamil plasma concentrations after either the IV or oral dose. The terminal elimination rate constant, clearance, volume of distribution, and bioavailability of verapamil were not significantly different between the two groups of subjects. In addition, the apparent maximal plasma concentration, terminal elimination rate constant, and area under the curve for norverapamil were similar in patients with renal failure and normal subjects. The study showed that the plasma disposition of verapamil and norverapamil was not affected in patients with impaired renal function. Furthermore, this study does not indicate that any change in dosage is necessary when single doses of verapamil are administered to patients with renal failure.     

Cooperation and rivalry between helping professionals and members of AA

Because Alcoholics Anonymous (AA) is an important resource for recovering alcoholics, most treatment centers want to work cooperatively with it. To identify factors that enhance this cooperation, the author surveyed AA members and professionals in the same communities and obtained a profile of their interactions, ideological similarities, and linking activities.     

Medullary thyroid cancer: a retrospective analysis of a cohort treated at a single tertiary care center between 1970 and 2005.

OBJECTIVE: To identify prognostic factors of clinical outcome and long-term survival in medullary thyroid cancer (MTC). DESIGN: Retrospective case series of 51 consecutive patients (mean age 46.9 years, 57% female) treated at a single tertiary university medical center from 1970 to 2005. Medical records were reviewed for demographic data, laboratory and clinical course, treatment, and long-term outcome. MAIN OUTCOME: At presentation, 25 patients (49%) had local disease and 26 (51%) had metastatic disease (three with distant metastases). RET mutations were identified in nine of 23 patients tested. The patients with hereditary disease were younger than the patients with sporadic disease (p < 0.001) and had lower calcitonin levels at diagnosis (p = 0.004) and more multicentric tumors (p = 0.02). Initial surgery consisted of total thyroidectomy in 47 patients, with neck dissection in 26; 22 patients achieved long-term remission. The 5-, 10- and 15-year survival rates were 88%, 85%, and 77%, respectively. On univariate analysis, distant metastases during the course of the disease and elevated calcitonin levels postoperatively were significant prognostic factors of reduced survival (p = 0.001 and 0.016, respectively). Lymph node involvement at initial surgery was associated with a lower remission rate (p = 0.016) but had no impact on long-term survival (p = 0.269). CONCLUSION: Patients with MTC have a generally favorable outcome, perhaps owing to recent advances in diagnosis and treatment. Although postoperative serum calcitonin level and distant metastases are the only determinants of long-term survival, the presence of cervical metastases is predictive of a higher risk of recurrent or persistent disease.