New and Low-Cost Auto-Algometry for Screening Hypertension-Associated Hypoalgesia

Objective:   The aim of the present work was to measure the pain threshold in hypertensive patients with a new auto-algometry method.
Design and Setting:   Auto-algometry consists of asking the subjects to push their fingers against a fixed round-tip needle until they feel a pain sensation. An electronic force transducer permits the measurement of the force applied by the subjects and storage of the data on a personal computer. Eight tests are performed twice on each subject on the tip and back of four fingers. For each test, the maximal applied force (grams) is defined as pain threshold. The overall discomfort during the entire procedure is reported by the subjects on a 0 (no discomfort) to 10 (intolerable pain) scale.
Patients and Interventions:   A group of hypertensive patients ( n  = 22) and a group of normotensive subjects ( n  = 22) underwent the auto-algometry examination.
Results:   The pain threshold was higher in hypertensive patients compared with normotensive subjects. All discomfort scores referred by the subjects fell within the 4–6 range.
Conclusion:   The data obtained from this study indicate that the auto-algometer as described here can detect hypoalgesia associated with hypertension.     

Trans fat intake lowers total cholesterol and high-density lipoprotein cholesterol levels without changing insulin sensitivity index in Wistar rats

Epidemiologic studies have demonstrated that trans fat intake increases the risk of some chronic diseases. We hypothesize that trans fat intake would increase the risk of cardiovascular disease and type 2 diabetes mellitus by changing the lipid profile in plasma, the secretion of adipokines in adipose tissue, and the insulin sensitivity. Accordingly, the major objective of present study was to investigate the effect of dietary intake of trans fat on lipid profile, insulin sensitivity, and adipokine levels in plasma. Two groups of Wistar rats were fed a diet containing 4.5% trans fat or a control diet containing no trans fat for 16 weeks. Fasting glucose level was monitored every 2 weeks. At the end of feeding experiment, blood, heart, kidney, liver, omental adipose tissue, and semitendinosus muscle were collected. The trans fat content in organs, lipid profile, adipokine, insulin, and glucose levels in plasma were analyzed. The trans fat content in adipose tissue, heart, kidney, liver, and muscle of rats fed trans fat were 169.9, 0.6, 1.2, 1.7, and 2.5 mg/g samples, respectively. The trans fat content in these organs contributed to 15.9%, 1.2%, 2.3%, 4.3%, and 6.1% of the total fat, respectively. The plasma glucose level, insulin level, and insulin sensitivity index were not significantly different between the trans fat and control groups. The results indicated that trans fat intake might not be related to insulin resistance. However, lipid profile and plasma adipokine levels were significantly changed after trans fat feeding. The trans fat fed group showed significantly lower total cholesterol and high-density lipoprotein cholesterol levels than the control group. The decreased high-density lipoprotein cholesterol level may indicate the detrimental effect of trans fat intake on lipid profile. Adiponectin and resistin levels were significantly higher in the trans fat group than the control group. Leptin levels were significantly lower in the trans fat group than the control group. The results indicated that dietary intake of trans fat can significantly change the adipokine levels, but the possible links between adipokine level change caused by trans fat intake and metabolic effects of this change need further investigations.     

Persons with multiple disabilities accessing stimulation and requesting social contact via microswitch and VOCA devices: New research evaluation and social validation

The first of these two studies assessed whether 11 participants with multiple disabilities of 5.3–18.2 (M = 10.7) years of age would succeed in combining a microswitch for accessing preferred environmental stimuli and a Voice Output Communication Aid (VOCA) for requesting social contact. The second study conducted a social validation assessment of the aforementioned microswitch–VOCA combination. Data showed that all participants learned to use the microswitch and the VOCA. Moreover, the 10 participants, who received a 1-month post-intervention check, largely maintained their responding. The social validation assessment indicated that the raters (i.e., 110 university psychology students) favored the combination of microswitch and VOCA over the microswitch or the VOCA alone, and hypothetical combinations of microswitches or VOCAs.     

E‐PTFE (Gore‐Tex®) implant with or without low‐dosage mitomycin‐C as an adjuvant in penetrating glaucoma surgery: 2 year randomized clinical trial

Purpose: To test the expanded polytetrafluoroethylene (ePTFE) as a new adjuvant in trabeculectomy. Methods: Consecutive glaucoma surgical inpatients were observed at the Department of Ophthalmology of Palermo University. Sixty patients (60 eyes) were randomly assigned to undergo trabeculectomy (T), trabeculectomy with mitomycin‐C (TMMC), with ePTFE (TG) or with mitomycin‐C and ePTFE (TGMMC). Postoperative visits were scheduled at 24 hr, 7 days, 1, 3, 6, 12, 18 and 24 months. Complete success and qualified success were assessed at two target intraocular pressure (IOP) levels –≤21 and ≤17 mmHg – by Kaplan–Meier curves. Results: The postoperative IOP reduction was significant (P < 0.01) at the endpoint in all groups, with a mean IOP of 16.9 (±2.9), 16.2 (±2.7), 15.3 (±3.4) and 15.2 (±4.3) mmHg in T, TMMC, TG and TGMMC eyes, respectively. No intergroup difference was found at either IOP targets. The Kaplan–Meier curves relating to either the ≤21 mmHg or the ≤17 mmHg target IOP did not show significant intergroup differences for complete and qualified success rate. When ePTFE was used, a trend favouring the medium‐term survival rate was noted. No adverse reaction to the ePTFE was present, and no membrane extrusion or conjuctival erosion were noted in any cases. Hypotony was significantly more frequent (P = 0.035) in groups without ePTFE. Moreover, the late MMC‐related complications were more frequent when MMC was applied. Conclusion: Expanded polytetrafluoroethylene implant in trabeculectomy is well tolerated and could act as a filtration modulating device. Therefore, it is useful in reducing early hypotony‐related complications and contributes to attaining medium‐term IOP control that is comparable to the low‐dosage MMC.     

Severe primary malnutrition in US children

We studied 16 children aged 18 months or less who had severe primary protein-calorie malnutrition. All were admitted to one urban pediatric teaching hospital for treatment of failure to thrive between Jan 1, 1980, and Aug 30, 1984. The definitions of malnutrition were based on those of the Wellcome Trust. The patients had no evidence of medical causes for their conditions and grew rapidly when they were refed in the hospital. Eight were products of teenage pregnancies. Eleven patients were receiving public aid, and four had no third-party coverage. All were markedly below the fifth percentile in weight for length; their mean percentage of expected weight for age was 0.55. The mean hospital stay was 18.5 days. Severe primary protein-calorie malnutrition does exist in the United States. Thorough nutritional evaluation in children with failure to thrive is indicated, and malnutrition should be a reportable condition in the United States.     

Munchausen syndrome presenting as gross hematuria in two women

Munchausen syndrome is an uncommon disorder in which patients present with fictitious disorders and a self-destructive urge to undergo invasive procedures. We present 2 cases of nurses who presented with recurrent urinary tract infections, flank pain, and gross hematuria. One patient had such severe hematuria as to require transfusions of more than 1000 U of packed red cells during a 30-year period. Both patients underwent extensive investigations--all of which were normal. One patient even underwent nephrectomy, which showed normal pathologic findings. Both were found to be phlebotomizing themselves and infusing blood into their bladders.     

Gleason score predicts androgen independent progression after androgen deprivation therapy

OBJECTIVE: The Gleason system is the most widely utilized histologic grading system for prostate cancer and a powerful predictor of cancer behavior. In this study, we evaluated the prognostic value of the Gleason grading system in predicting progression to androgen independent prostate cancer (AIPC). METHODS: Records from 150 patients with advanced or metastatic prostate cancer treated with androgen deprivation therapy (ADT) were retrospectively reviewed. Androgen independent progression was defined as two consecutive elevations of serum prostate specific antigen (PSA) above the nadir value. Kaplan-Meier and the Cox proportional hazards methods were used to assess potential predictors of progression to AIPC. RESULTS: Patients with low and moderate Gleason scores experienced significantly longer remissions compared to those with Gleason score of 8-10 (p=0.0006, Log-Rank test). The cumulative hazard of progressing to AIPC increased by almost 70% for each unit increase in total Gleason score. CONCLUSION: In this patient cohort the Gleason score was the only independent predictor of progression to AIPC.     

Quality-of-life assessment in patients who had been surgically treated for cerebellar pilocytic astrocytoma in childhood

OBJECT: After radical surgery for childhood cerebellar astrocytomas, patients are considered to be cured. Long-term follow up demonstrates that these patients survive, with most of them leading a normal life. The study reported here was aimed at assessing the quality of life (QOL) of these adults, which is defined as a person's sense of well-being, as derived from his or her current experience of life as a whole. METHODS: Twenty patients who had undergone surgery between 1970 and 1985 were enrolled in the study. In four patients ventriculoperitoneal shunts were in place; two of these patients had required more than six shunt revisions. At present, all patients have clear neuroimaging studies and their Karnofsky Performance Scale (KPS) scores are as follows: 70 in three, 80 in seven, 90 in six, and 100 in four. A QOL questionnaire was administered to the patients and to a control group consisting of 20 healthy volunteers of matching age and sex. The chi-square test was applied to compare patients and controls. Traditional questions on the level of education, work, whether the patients have their own families, and whether they possessed a driver's license were asked at the end of the questionnaire. In all the dimensions assessed except one (sex life), the difference between patients and control volunteers was significant, socializing and adolescence being the most striking ones. This was also true when the three patients with the lowest KPS scores and the worst QOL results were excluded. CONCLUSIONS: By traditional standards, these patients appear to fare quite well. Nevertheless, their self-reported life experience is unsatisfying when compared with the control group. The authors conclude that psychosocial factors are critical to complete recovery and the QOL of children who undergo successful operations for benign cerebellar astrocytoma.