Trichomonal vaginitis refractory to treatment: case report.

A woman initially aged 25 was treated for seven years for symptomatic vaginal trichomoniasis. Throughout that period the patient received 5-nitroimidazoles at conventional and high dosages, antimicrobial agents to eliminate vaginal organisms capable of interfering with treatment, acidifying preparations, and vaccination with inactivated Lactobacillus acidophilus. Despite all the regimens used, the condition remained refractory to treatment.     

Vascular endothelial growth factor C is required for sprouting of the first lymphatic vessels from embryonic veins

Lymphatic vessels are essential for immune surveillance, tissue fluid homeostasis and fat absorption. Defects in lymphatic vessel formation or function cause lymphedema. Here we show that the vascular endothelial growth factor C (VEGF-C) is required for the initial steps in lymphatic development. In Vegfc-/- mice, endothelial cells commit to the lymphatic lineage but do not sprout to form lymph vessels. Sprouting was rescued by VEGF-C and VEGF-D but not by VEGF, indicating VEGF receptor 3 specificity. The lack of lymphatic vessels resulted in prenatal death due to fluid accumulation in tissues, and Vegfc+/- mice developed cutaneous lymphatic hypoplasia and lymphedema. Our results indicate that VEGF-C is the paracrine factor essential for lymphangiogenesis, and show that both Vegfc alleles are required for normal lymphatic development.     

Characteristics of motile curved rods in vaginal secretions

Motile curved rods seen in vaginal secretions have been isolated on Columbia agar supplemented with 5% human blood and vitamin K. Growth occurred anaerobically and in 5% oxygen but not in more aerobic conditions. There were two distinct groups of these organisms, distinguishable by morphology, biochemical activity and susceptibility to metronidazole. All isolates were sensitive to a wide range of antimicrobial agents, with the exception of nalidixic acid and polymyxin, but one group was resistant to metronidazole. There was little difference between the results of tests of susceptibility to aminoglycosides or to metronidazole performed in anaerobic and microaerophilic conditions. Motile curved rods were isolated from 18 of 80 patients with a clinical diagnosis of non-specific vaginitis, but from only two of 39 without the disease.     

Intestinal pseudo-obstruction in patients with systemic lupus erythematosus: A real diagnostic challenge

Intestinal pseudo-obstruction secondary to systemic lupus erythematosus (SLE) is a rare syndrome described in recent decades. There are slightly over 30 published cases in the English language literature, primarily associated with renal and hematological disease activity. Its presentation and evolution are a diagnostic challenge for the clinician. We present four cases of intestinal pseudo-obstruction due to lupus in young Mexican females. One patient had a previous diagnosis of SLE and all presented with a urinary tract infection of varying degrees of severity during their evolution. We consider that recognition of the disease is of vital importance because it allows for establishing appropriate management, leading to a better prognosis and avoiding unnecessary surgery and complications.     

Simulation of Leather Visco-Elastic Behavior Based on Collagen Fiber-Bundle Properties and a Meso-Structure Network Model

Simulation-based prediction of mechanical properties is highly desirable for optimal choice and treatment of leather. Nowadays, this is state-of-the-art for many man-made materials. For the natural material leather, this task is however much more demanding due to the leather’s high variability and its extremely intricate structure. Here, essential geometric features of the leather’s meso-scale are derived from 3D images obtained by micro-computed tomography and subsumed in a parameterizable structural model. That is, the fiber-bundle structure is modeled. The structure model is combined with bundle properties derived from tensile tests. Then the effective leather visco-elastic properties are simulated numerically in the finite element representation of the bundle structure model with sliding contacts between bundles. The simulation results are validated experimentally for two animal types, several tanning procedures, and varying sample positions within the hide. Finally, a complete workflow for assessing leather quality by multi-scale simulation of elastic and visco-elastic properties is established and validated.     

Pain treatment of fibromyalgia by acupuncture

The lack of objective parameters makes the measurement of pain and the efficacy of pain treatment in patients with chronic pain very difficult. We performed acupuncture therapy in fibromyalgia patients and established a combination of methods to objectify pain measurement before and after therapy. The parameters corresponded to patients' self-report. Twenty-nine fibromyalgia patients as defined by ACR-criteria (25 women, 4 men) with a mean age of 48.2±2.0 years and a mean disease duration of 6.1±1.0 years participated in the study. Pain levels and positive tender points were assessed using the visual analogue scale (VAS, i.e., range 0–100 mm) and dolorimetry. Serotonin and substance P levels in serum and the serotonin concentration in platelets were measured concomitantly. During acupuncture therapy no analgesic medication was allowed. The VAS scores decreased from 64.0±3.4 mm before therapy to 34.5±4.3 mm after therapy (P<0.001). Dolorimetry revealed a decreased number of tender points after therapy from 16.0±0.6 to 11.8±1.0, P<0.01. Serotonin levels decreased from 715.8±225.8 μg/10¹² platelets to 352.4±47.9 μg/10¹² platelets (P<0.01), whereas the serum concentration increased from 134.0±14.3 ng/ml to 171.2±14.6 ng/ml (P<0.01). Substance P levels in serum increased from 43.4±3.5 pg/ml to 66.9 ±8.8 pg/ml (P<0.01). Acupuncture treatment of patients with fibromyalgia was associated with decreased pain levels and fewer positive tender points as measured by VAS and dolorimetry. This was accompanied by decreased serotonin concentration in platelets and an increase of serotonin and substance P levels in serum. These results suggest that acupuncture therapy is associated with changes in the concentrations of pain-modulating substances in serum. The preliminary results are objective parameters for acupuncture efficacy in patients with fibromyalgia. Received: 15 May 1997     

Collagen crosslinks in fibromyalgia

Objective. To determine if abnormal collagen metabolism is a characteristic of fibromyalgia. Methods. The diagnosis of fibromyalgia was made according to the American College of Rheumatology criteria. Skin biopsy samples were obtained from the trapezius region of 8 patients with fibromyalgia. Urine was collected under standardized conditions from 55 control subjects and 39 patients with fibromyalgia, and serum was obtained from 17 controls and 22 patients with fibromyalgia. Pyridinoline (Pyd), an indicator of connective tissue disease, and deoxypyridinoline (Dpyd), an indicator of bone degradation, both of which represent products of lysyl oxidase-mediated crosslinking in collagen, were analyzed by ion-paired and gradient high-performance liquid chromatography (HPLC) methods with fluorescence detection. Levels of hydroxyproline (Hyp), a collagen turnover marker, were also measured. The findings were related to creatinine levels, and the Pyd:Dpyd ratio was determined. Results. Highly ordered cuffs of collagen were observed around the terminal nerve fibers by electron microscopic examination of biopsy tissue from all 8 patients with fibromyalgia, but were not observed in any of the control skin samples. The Pyd:Dpyd ratios in the urine and serum and the Hyp levels in the urine were significantly lower in patients with fibromyalgia than in healthy controls. Conclusion. Decreased levels of collagen cross-linking in fibromyalgia may contribute to remodeling of the extracellular matrix and collagen deposition around the nerve fibers, and may contribute to the lower pain threshold at the tender points. Analysis of altered collagen metabolism either by histologic examination on biopsy, or preferably, by HPLC analysis of collagen metabolites in urine or serum may aid in understanding more about the pathogenesis of fibromyalgia.     

Health Disparities Among Kinky Sex Practitioners

Purpose of review

This review is to characterize the theoretical and empirical literature about alternative sexual behaviors, predominantly known under the umbrella of bondage and discipline, dominance and submission, and sadism and masochism (BDSM, also known as “kink”). The overview is to aid the clinician in understanding how particular studies might fit into the larger context of the scholarly and empirical literature in order to judge the generalizability of conclusions. The specific concern of whether there are health disparities for this stigmatized sexuality is considered and explored.

Recent findings

The literature contains a wide range of positions and perspectives, ranging from always pathologizing BDSM behavior to proposing therapeutic functions of BDSM behavior. There are significant differences across professions in treatment of BDSM, and the medical literature is noted for being disorganized and piecemeal and starting to change over the past 5 years in ways that addresses the earlier problematic approaches that may have hindered clinical practice.

Summary

Empirical evidence suggests significant stigma impacting the health of BDSM-identified patients and impacting the healthcare service provided to kinky sex practitioners. The empirical and scholarly literature about BDSM or kink demonstrates a trend that addresses the stigma of alternative sexualities, but more work is needed.

     

31P magnetic resonance spectroscopy in fibromyalgic muscle

OBJECTIVE: To measure inorganic phosphate (Pi), phosphocreatine (PCr), ATP and phosphodiesters (PDE) in fibromyalgic muscle tissue by (31)P magnetic resonance spectroscopy. METHODS: A 1.5 Tesla scanner with a P 100 surface coil was used to examine 15 patients (mean age 49.9+/-14.3 yr) with fibromyalgia, according to the American College of Rheumatology criteria, and 17 healthy controls (mean age 30.2+/-5.8 yr). RESULTS: Compared with the controls, there were increases in the levels of PDE (+22%, P = 0.032) and Pi (+19%, P = 0.019) in the spectra of fibromyalgia patients, but there was no difference in pH. CONCLUSION: The metabolic differences we found may have been related to weakness and fatigue in the fibromyalgia patients, but they do not fully explain the fibromyalgia symptoms.