Treatment and recovery for sexual addicts

Over the last 10 years, primary health care practitioners have seen an increase in their case loads of persons with chronic addictive illnesses (e.g., alcohol- and drug-related illnesses, eating disorders, spending addictions). The management of chronic illnesses usually is aimed at restoring a level of health and reinforcing a positive lifestyle so that a person can manage the illness rather than having it cured and its effects eradicated. Practitioners can apply the treatment modalities already being used in the management of chronic and addictive illnesses to treat the most newly emerging addictive illness--sexual addiction. Following the premise that a person needs to be involved with other people who have the illness, treatment and recovery are based on a 12-step recovery-group process. Additionally, sexually addicted clients need medical and emotional therapy. This article focuses on understanding the decision-making process involved in the care of patients with sexual addiction, and presents tools and resources to help in managing this illness.     

Altered folate and vitamin B12 metabolism in families with spina bifida offspring

Folic acid intake reduces the risk of neural tube defects (NTDs). Although the 677C-->T mutation in the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene is a risk factor for NTDs, it only partly explains the elevated homocysteine levels in mothers of children with NTDs. We measured vitamin B12, folate and homocysteine in patients with spina bifida (SB), their parents, and in controls, to investigate which other enzymes of homocysteine metabolism might be defective. Because homozygosity for the 677C-->T mutation causes decreased plasma folate and increased red-cell folate (RCF) and plasma homocysteine levels, we excluded individuals homozygous for that mutation. The remaining SB patients and their parents still had lowered plasma folate and elevated total homocysteine levels, and a small subset had decreased vitamin B12 levels. Red-cell folate was the same in all groups, suggesting that dietary folate intake and its uptake was normal. Risk of SB was increased at the 25th percentile of plasma folate and at the 75th percentile of homocysteine values in SB patients and their parents, and at the 5th and 25th percentiles of vitamin B12 in mothers with SB- affected offspring. This underlines the functional importance of homocysteine remethylation to methionine. There was no correlation between vitamin B12 and homocysteine or RCF. In combination with the lowered plasma folate (80-90% 5-methyltetrahydrofolate), our data do not support a major involvement of methionine synthase in the aetiology of SB. Our data rather favour the involvement of genetic variation at loci coding for the formation of 5-methyltetrahydrofolate, such as MTHFR, methylenetetrahydrofolate dehydrogenase or serine hydroxymethyltransferase.      

Sickle erythrocytes adhere to polymorphonuclear neutrophils and activate the neutrophil respiratory burst

The vasoocclusive process in patients with sickle cell disease (SCD) is complex and involves interactions among sickle erythrocytes (SS-RBC), vascular endothelium, and plasma and cellular components. The role of neutrophils (PMN) in vasoocclusion has not been examined. Patients with SCD appear to have chronically activated PMN. Because the first step in PMN activation is particle recognition, we explored whether normal PMN recognize SS-RBC and whether this recognition results in PMN monolayers, significantly more SS-RBC adhered to the PMN than did normal erythrocytes (AA-RBC; P < .001). Preincubation of erythrocytes with autologous plasma significantly increased the adherence of SS-RBC to PMN but had no effect on AA-RBC (P < .001). When adhesion of density fractionated SS-RBC was performed, dense SS-RBC showed greater adherence to the PMN monolayers than did light SS-RBC (P < .001). To determine mechanisms of this adhesion, IgG and Arg-Gly-Asp-Ser (RGDS) receptor sites on PMN were saturated. IgG inhibited adherence of dense SS-RBC, whereas RGDS inhibited adherence in both fractions, although to a greater extent in the light fraction. We measured SS-RBC activation of PMN by incubating SS-RBC with 2', 7'-Dichloro-fluroescin Diacetate (DCF)-labeled PMN. Incubation of PMN with SS-RBC resulted in a significant increase in fluorescence compared to AA-RBC. We show here that PMN recognize SS-RBC through multiple mechanisms and that this recognition results in activation of PMN. These findings contribute to the understanding of vasoocclusive crisis in patients with SCD and may have therapeutic implications.     

Early clinical experience with hydroxyapatite-coated femoral implants.

As part of a multi-center study, 238 titanium stems that were proximally coated with hydroxyapatite were implanted in 220 patients between January 1988 and December 1989. Ninety-two of these stems in eighty-three patients had a minimum of two years of follow-up, including analysis of the clinical and radiographic data. Clinically, the patients were essentially pain-free before six months and had a low (4 per cent) prevalence of pain in the thigh and a very high composite Harris hip-score (mean, 95 points) at two years. Radiographically, subsidence was detected in 8 per cent of the implants; no implant had more than three millimeters of subsidence. Radiolucencies were characteristically seen around the uncoated distal part of the stem, in 70 per cent of the implants. Contrastingly, radiolucencies were rare in the hydroxyapatite-coated proximal zones and were most often found anteriorly, in only 5 per cent of the implants. Areas of increased formation of cancellous bone were seen beneath femoral cortical bone at the interface between the hydroxyapatite-coated and uncoated parts of the stem, in 67 per cent of the implants. Calcar resorption was found in 49 per cent of the implants. Cortical thickening was present in 17 per cent of the implants at the uncoated distal part of the stem. Two of the 238 femoral implants were revised: one because of infection and one because of aseptic loosening associated with non-union of a subtrochanteric osteotomy.     

Amino acid profile in Down's syndrome

Fasting plasma and urinary amino acid concentrations were studied under carefully controlled conditions in 22 children with Down's syndrome and in age matched controls. The only significant difference between the groups was a higher mean plasma lysine concentration in Down's syndrome patients compared to controls.     

Prostatic hyperplasia: radiological intervention. Work in progress

Benign prostatic hypertrophy is the most common cause for urethral obstruction in males over 50 years of age. Interventional radiologic dilatation under fluoroscopic control offers a nonoperative alternative for treatment of prostatic hyperplasia. Cadaver studies with the use of arteriographic balloon catheters indicated that manual injection pressure provides effective dilatation of the prostatic urethra. Evaluation of symptom relief will have to await patient studies.     

Evaluation of tension and compression forces in the canine femur in vivo

Summary In order to verify the existence of tension and compression forces from the cortical surface of canine femora, rosette strain gauges and a radio telemetry system were used to observe the animals during normal locomotion. Surface strain measured from the lateral cortical surface was consistently in tension whereas surface strain measured from the medical cortical surface was in compression. This data supported in vitro work which showed that eccentric loading of bone results in the convex side of bone being in tension and the concave side of bone being in compression.

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Zusammenfassung Spannungs- und Druckkräfte auf der kortikalen Oberfläche des Femurs beim Hund wurden geprüft. Um die Verhältnisse beim freien Bewegungsablauf beobachten zu können, wurden Rosetten-Belastungsmeßgeräte und ein drahtloses Telemetriesystem verwendet. Die abgeleiteten Belastungsmessungen ergaben, daß die laterale Kortexoberfläche regelmdßig unter Spannung stand, während die mediale Kortexoberfläche unter Druck stand. Dieses Ergebnis bestätigt das in vitro Resultat, welches zeigte, daß exzentrisches Belasten von Knochen zu Spannung in der konvexen Seite und Druck in der konkaven Seite des Knochens führt.

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Supported by the J. P. Bickell Foundation, University of Toronto, Toronto, Ontario, Canada