Iotrol versus metrizamide in lumbar myelography: a double-blind study

In a prospective, randomized, double-blind study, 49 patients underwent lumbar myelography using iotrol (24 patients) or metrizamide (25 patients). The diagnostic imaging adequacy of iotrol was comparable with that of metrizamide. After iotrol myelography, adverse reactions were fewer, less severe, and of shorter duration than were those following metrizamide myelography. Thirteen of 24 patients (54%) receiving iotrol reported some adverse reactions compared with 24 of 25 patients (96%) receiving metrizamide. Five moderate and one severe adverse reaction occurred in the group receiving iotrol. Fourteen moderate and eight severe adverse reactions occurred in the group receiving metrizamide. Thirty-eight patients underwent electroencephalography both before and after myelography (19 iotrol and 19 metrizamide). None of the EEGs obtained after iotrol myelography changed from baseline, while seven of the EEGs obtained after metrizamide myelography showed changes from baseline. Iotrol was judged superior to metrizamide as a contrast medium in this patient population.     

Detailed family history of diabetes identified children at risk of type 2 diabetes: a population‐based case‐control study

Wei J‐N, Li H‐Y, Wang Y‐C, Chuang L‐M, Lin M‐S, Lin C‐H, Sung F‐C. Detailed family history of diabetes identified children at risk of type 2 diabetes: a population‐based case‐control study. Objectives: Recently, the incidence of type 2 diabetes (T2D) in children has increased dramatically. Mass screening is suffering and costly. It remains unknown if a detailed family diabetes mellitus history (FDMH) can identify children with different risks of T2D. This study investigated how FDMH was associated with childhood T2D. Methods: From 1992 to 1997, a nationwide survey conducted in Taiwan for all 3 000 000 school children aged between 6 and 18 yr identified 1966 children with diabetes. For comparison, 1780 children were randomly selected as the control group from all students with normal fasting glycemia (NFG). Telephonic Interviews were conducted using questionnaire for detailed FDMH. In the present analysis, 505 children with T2D and 619 children with NFG were enrolled. Results: Children with more family members having diabetes were more likely to have T2D. Children with the parental FDMH had a higher risk for T2D than children with the grandparental FDMH; the odds ratios (ORs) were 2.61 (95% confidence interval (CI) 1.25–5.48, p < 0.05) for boys and 6.47 (95% CI 2.69–15.6, p < 0.05) for girls, adjusting for age, birth weight, gestational age and body mass index (BMI) z‐score. Children with maternal FDMH had a higher risk for T2D than children with paternal FDMH, and much greater in boys (OR = 29.5, 95% CI 3.67–237, p < 0.05) than in girls (OR = 7.63, 95% CI 2.05–28.4, p < 0.05), adjusted for age, birth weight, gestational age, BMI z‐score, and FDMH in grandparents. Conclusions: Children with parental FDMH, especially the maternal FDMH, have an elevated risk for T2D. Detailed FDMH is a convenient alternative to identify children with different risks of T2D.     

One-stage correction of proximal hypospadias and penoscrotal transposition.

BACKGROUND AND PURPOSE: Total correction of proximal hypospadias and penoscrotal transposition (PST) is a challenge to surgeons. Staged operation is usually recommended because the blood supply to the neourethra or the skin covering the penile shaft may be severed during scrotoplasty. This paper describes results obtained using a new technique for total correction, which preserves the blood supply to the neourethra in a one-stage operation. PATIENTS AND METHODS: Between July 1998 and March 2000, five boys (mean age 4 yr) with proximal hypospadias and PST underwent total correction in a one-stage operation. The urethral meatus of these patients was located at mid shaft in one, at the penoscrotal junction in two, and at the scrotum in two. Hypospadias was repaired using the Snodgrass procedure and PST was corrected using the Ehrlich and Scardino technique. Radical bulbar urethra dissection and tunica albugineal plication were used to correct penile curvature in all five cases. The urethral stent was removed on the seventh or eighth postoperative day. The meatus was then dilated using the cone tip of an ophthalmic ointment tube two or three times per day for 2 to 4 weeks. Postoperative urinary flow was observed in the outpatient clinic. RESULTS: The mean follow-up period was 11.2 months. There was no postoperative fistula. One patient had postoperative meatal stenosis that was successfully treated by dilation. Postoperatively, the penile base was well above the scrotal rhugae and the meatus was at the tip of the glans in each patient. The postoperative urinary flow was straight in all patients. CONCLUSION: Combining Snodgrass hypospadias repair and Ehrlich and Scardino PST repair in a one-stage operation preserved the blood supply to the neourethra and achieved excellent functional and cosmetic results.     

Association study of novel human serotonin 5-HT(1B) polymorphisms with alcohol dependence in Taiwanese Han.

BACKGROUND: Abnormal serotonergic pathways are implicated in numerous neuropsychiatric disorders, such as depression, anxiety, migraine, substance abuse, and alcoholism. The human serotonin receptor 1B, encoded by the HTR1B gene, is a presynaptic serotonin autoreceptor that plays a role in regulating serotonin synthesis and release. Because the linkage of antisocial alcoholism to the HTR1B gene was recently reported in two populations, it was of interest to identify genetic variants at the HTR1B locus and study their association with alcoholism in the Taiwanese Han population. METHODS: We sequenced DNA from Taiwanese Han to screen for genetic variation in the coding, promoter, and partial 3' untranslated regions of the HTR1B locus of 158 alcohol-dependent cases with withdrawal symptoms and 149 control subjects, who either never drank or drank only occasionally and in low quantities. RESULTS: Seven variants were identified. Positive associations were found between variant A-161T and alcohol dependence at both the allelic and genotypic level. In addition, an expression study showed that the A-161T variant affected reporter gene activity. CONCLUSIONS: Our results support an association between HTR1B and alcohol dependence. The HTR1B A-161T polymorphism may be valuable both as a functional and as an anonymous genetic marker for HTR1B.     

Urinary nerve growth factor level is correlated with the severity of neurological impairment in patients with cerebrovascular accident

OBJECTIVE

To measure urinary nerve growth factor (uNGF, essential in nerve growth and regeneration) levels in patients with a cerebrovascular accident (CVA), to determine whether uNGF could be a biomarker for predicting the neurological deficits in CVA, as the level of uNGF increases in patients with idiopathic detrusor overactivity (DO) and incontinence.

PATIENTS, SUBJECTS AND METHODS

uNGF levels were measured using an enzyme‐linked immunosorbent assay in normal subjects and patients with CVA and different severities of neurological impairment. Total uNGF levels were normalized to the concentration of urinary creatinine (uNGF/Cr).

RESULTS

The median (interquartile range) uNGF/Cr levels were significantly higher in patients, at 0.13 (0–1.04), than in normal subjects (undetectable). The uNGF/Cr levels correlated well with the severity of neurological impairment. Patients with none/minimal neurological impairment had no detectable uNGF/Cr level, like the controls. Patients with mild/moderate impairment had levels of 0.27 (0.09–0.8) and with severe impairment level of 1.53 (0.5–3.0) (both P < 0.001), significantly greater than that of none/minimal impairment or controls. However, uNGF/Cr levels were not correlated with age, location of CVA, multiplicity of CVA, duration of CVA, urodynamic findings or the presence of urge urinary incontinence.

CONCLUSIONS

The uNGF level is correlated with the severity of neurological impairment in patients with CVA but not with urge symptoms or urodynamic findings, suggesting elevated uNGF might be a result of the neurological lesion rather than lower urinary tract dysfunction in CVA.     

Translation and cultural adaptation of the patient disease and treatment assessment form: A novel quality of life instrument for use in Taiwan

Aim: Quality of Life (QoL) is an important end‐point in cancer clinical trials, but its collection in multinational trials requires properly translated and validated instruments. We describe the development, piloting and planned validation of a traditional Chinese version of the Patient Disease Treatment and Assessment Form (Pt DATA Form) for use in Taiwan. Methods: The Pt DATA Form is a simple, multi‐item QoL instrument based on 11‐point numeric rating scales for a range of relevant symptoms and functions and aspects of well‐being, designed for use in routine clinical practice and clinical trials. The instrument underwent forward translation in Sydney and backward translation in Taiwan. A reconciled version was pre‐tested on healthy volunteers and then on 20 cancer patients in a Taiwanese clinic. Results: One hundred percent of patients reported that the items were clear and did not cause upset. Eighty five percent had no difficulty in completing the form while 10% found it fairly difficult. There were no difficulties with the instructions. Conclusion: This questionnaire was acceptable for use in Taiwan in its current format and will allow the collection of innovative data on Chinese cancer patients' experiences.     

Self‐worth therapy for depressive symptoms in older nursing home residents

Title. Self‐worth therapy for depressive symptoms in older nursing home residents. Aim. The aim of this study is to report the effects of self‐worth therapy on depressive symptoms of older nursing home residents. Background. Depression in older people has become a serious healthcare issue worldwide. Pharmacological and non‐pharmacological therapies have been shown to have inconsistent effects, and drug treatment can have important side‐effects. Method. A quasi‐experimental design was used. Older people were sampled by convenience from residents of a nursing home in northern Taiwan between 2005 and 2006. To be included in the study participants had to: (i) have no severe cognitive deficits; (ii) test positive for depressive status and (iii) take the same anti‐depressant medication in the previous 3 months and throughout the study. Participants in the experimental group (n = 31) received 30 minutes of one‐to‐one self‐worth therapy on 1 day a week for 4 weeks. Control group participants (n = 32) received no therapy, but were individually visited by the same research assistant, who chatted with them for 30 minutes on 1 day/week for 4 weeks. Depressive status, cognitive status and functional status were measured at baseline, immediately after the intervention and 2 months later. Data were analysed by mean, standard deviations, t‐test, chi‐squared test and univariate anova . Findings. Self‐worth therapy immediately decreased depressive symptoms relative to baseline, but not relative to control treatment. However, 2 months later, depressive symptoms were statistically significantly reduced relative to control. Conclusion. Self‐worth therapy is an easily‐administered, effective, non‐pharmacological treatment with potential for decreasing depressive symptoms in older nursing home residents.