Ureterorenal endoscopy: which instrument, what cost?

This report describes the design, availability, repair facilities and costs of rigid ureteroscopes. Clinical factors affecting design are detailed. A classification is given. A new test of flow dynamics is described. Short operating ureteroscopes with a stable or integral telescope system appear to be superior to other types, especially as they may be used for antegrade ureteroscopy.     

Predictors of rapid and sustained response to cognitive-behavioral therapy for bulimia nervosa.

OBJECTIVE: To examine characteristics of individuals who show a rapid and sustained response to cognitive-behavioral therapy (CBT) for bulimia nervosa (BN). METHOD: As part of a randomized clinical trial designed to dismantle CBT for BN, we compared 19 individuals who exhibited complete abstinence from binging and purging after only eight sessions of CBT and maintained abstinence throughout the duration of treatment and the 1-year follow-up interval, to 79 individuals who had a more variable response to treatment. Demographics, baseline clinical characteristics, lifetime comorbidity, and personality disorder symptoms and profiles from the Temperament and Character Inventory were examined. RESULTS: In univariate analyses, frequency of binging and purging at baseline, low scores on the Eating Disorders Inventory (EDI) Bulimia subscale, lower harm avoidance, and higher self-directedness were associated with rapid response. In multiple regression analyses, frequency of binging at baseline (OR = 0.87; 95% CI 0.77-0.98) and self-directedness (OR = 1.12; 95% CI 1.04-1.21) independently predicted rapid and sustained treatment response. CONCLUSION: Frequency of binging and the character quality of self-directedness may be useful predictors of those individuals who are likely to respond positively to a brief course of CBT for BN.     

Treatment considerations with black incestuous families

This paper is concerned with father-daughter incest among blacks and the cultural and legal issues that tend to perpetuate incestuous behavior. From a decade of observations, the authors describe findings about the psychosocial and behavioral sequelae of this phenomenon in black families.     

Role of mechanical loading in the progressive ossification of a fracture callus

The progressive ossification pattern in a fracture callus was predicted based on a theory that relates the local stimulus for ossification to the tissue mechanical loading history. Two-dimensional finite element analyses of a fracture callus were considered at three different stages of ossification. The sites of callus ossification represented in the initial model were predicted by previous analyses relating mechanical stress and vascularity to the differentiation of mesenchymal tissue in the early callus. The zones of further ossification, bone bridging, and bone consolidation predicted in the present study were found to be similar to the ossification patterns that have been documented by other researchers. The approach used to predict fracture healing is identical to that of previous studies predicting joint morphogenesis, with the exception that fracture healing requires continuous, attached skeletal elements, whereas joint morphogenesis requires discontinuous, articulating skeletal elements.     

Spontaneous internal carotid artery dissection shown by magnetic resonance imaging

We have reported a case of spontaneous dissection of the internal carotid artery, with MRI and angiographic findings. We conclude that MRI is a beneficial noninvasive test for the detection and study of carotid artery dissection.     

Short-term desensitization of prostaglandin F2 alpha receptors increases cyclic AMP formation and reduces inositol phosphates accumulation and contraction in the bovine iris sphincter

The effect of short-term prostaglandin (PG) desensitization on PGF2 alpha receptor-mediated inositol phosphates accumulation, 1,2-diacylglycerol production, measured as phosphatidic acid (PA), myosin light chain (MLC) phosphorylation, cAMP formation and contraction was investigated in bovine iris sphincter smooth muscle. We have found that incubation of the sphincter with 25 microM PGF2 alpha for 45 min leads to: (a) significant loss in sensitivity of the tissue to PGF2 alpha receptor-stimulated inositol phosphates accumulation, PA production, MLC phosphorylation and contraction, and (b) significant increase in both basal and PGF2 alpha-stimulated cAMP formation. These changes are probably not due to reduction in phospholipid synthesis because there were no detectable differences in basal phospholipid labeling, either from 3H-inositol or from 32P, between normal and desensitized muscles. Preincubation of the sphincter in the absence of PGF2 alpha for 45 min did not lead to alterations in the biochemical-pharmacological responsiveness of the control muscle to PGF2 alpha. Our results suggest that desensitization of PG receptors in the iris sphincter occurs by a receptor-specific process. The PG receptor mediating contraction (IP3-Ca2+) is selectively susceptible to desensitization, in contrast with the receptor mediating smooth muscle relaxation (cAMP). These findings add further support to the developing hypothesis that there are functional and biochemical reciprocal interactions between the IP3-Ca2+ and cAMP messenger systems in the iris of the mammalian eye.     

Fatigue fractures of the femoral diaphysis in the skeletally immature simulating malignancy

The clinical and radiological features of three fatigue fractures developing along the medial aspect of the distal femoral diaphysis are described. All three patients were skeletally immature and were referred with the radiographic diagnosis of a probable sarcoma of bone. The plain radiographic findings consisted of an uninterrupted single lamella of periosteal new bone arising medially from the distal femoral diaphysis. Bone scans showed no evidence of hyperaemia on the vascular phase and revealed a fusiform focus of increased uptake in the postero-medial cortex of the lower femoral diaphysis on the 3-h images. Computed tomography showed increased attenuation of the medulla due to fibrosis and an absence of a soft-tissue mass. Periosteal callus was present and a cortical fracture through the medial femoral cortex was identified in two cases. The features that distinguish a fatigue fracture of the femur from a sarcoma are discussed.