Color Doppler appearance of penile cavernosal-spongiosal communications in patients with normal and impaired erection

Our objective was to investigate prevalence and Doppler characteristics of penile cavernosal-spongiosal communications (CSC). These vessels are either anastomoses connecting the cavernosal arteries with the urethral arterial network or afferent vessels to the corpus spongiosum. Sixty-one consecutive patients underwent penile color Doppler US. Waveform changes in CSC were evaluated in comparison with changes in the cavernosal artery. Eighteen of 61 patients had normal erection, 17 of 61 had arterial insufficiency, and 26 of 61 had veno-occlusive dysfunction. Resistance index (RI) in CSC was significantly lower than in cavernosal arteries in all patients and increased during phases 1-2 (positive diastolic flow). Peak systolic velocity (PSV) in CSC was significantly higher in the patients with veno-occlusive dysfunction. During cavernosal phase 4 (diastolic flow reversal) CSC of patients with normal erection or with arterial insufficiency disappeared, underwent markedly reduced diastolic flow, or had systolic flow inversion. Conversely, low resistance flow was appreciable in CSC of patients with veno-occlusive dysfunction who reached phase 4. During phase 5 (systolic peak reduction) all CSC disappeared. Color Doppler US allows evaluation of CSC both in patients with normal and impaired erection.     

Accelerated atherosclerosis during maintenance hemodialysis: detection from chest radiographs.

Evidence of accelerated atherosclerosis was studied from chest radiographs of 26 patients on maintenance hemodialysis. The aortic knob was observed for presence of and increase in calcified plaques. At the initiation of hemodialysis, the degree of aortic calcification was no different from that seen in the control group. After periods ranging from one and a half to eight years, the patients on hemodialysis showed a significantly greater amount of aortic calcification and a significantly higher rate of calcification. The degree of calcification correlated with the severity of cardiovascular disease as determined clinically. For patients on maintenance hemodialysis, close scrutiny of serial chest-radiographs may help to identify those who are at greater risk for life-threatening cardiovascular disease.     

End-to-End Ureteral Anastomosis: A Simple Alternative to Cutaneous Ureterostomy in Selected Patients

End-to-end of terminal ureteral segments seems to be a good alternative to terminal cutaneous ureterostomy in very selected cases (patients with short life-expectancy or when it is impossible to utilize the bowel for urinary diversion). Background: An end-to-end ureteral anastomosis (UA) drained by a single percutaneous nephrostomy is proposed as an alternative to permanent cutaneous ureterostomy. Methods: In eight patients who underwent radical cystectomy, an end-to-end UA was realized. All patients had an advanced pelvic neoplasm and/or severe comorbidities with a short life-expectancy. Results: End-to-end UA is a very simple intervention, well tolerated by the patient that requires only the periodic substitution of the nephrostomy. Conclusions: In very selected cases (patients with short life-expectancy, advanced disease) end-to-end UA is a quick and easy way to divert the urine after bladder removal.     

Association of ambulatory blood pressure and dietary caffeine in adolescents

BACKGROUND: Although relatively little is known about the responsible factors, there is an increased prevalence of essential hypertension in youth. Our previous research using casual blood pressure (BP) suggests a role for caffeine intake. The objective of this study was to assess the association between caffeine intake and ambulatory BP patterns among adolescents and to replicate our previous findings that compared caffeine intake to BP values obtained at a single time point. METHODS: Eighty-two African-American and non-Hispanic white adolescents (15 to 19 years old) with normal systolic BP selected foods and beverages for a 4-day sodium-controlled diet. Subjects were stratified into three groups based on the amount of caffeine in these foods. Ambulatory BP measures (24-h) were recorded during 1 day of the 4-day diet. The effects of ethnicity, caffeine, and the interaction of ethnicity and caffeine on BP were assessed for daytime and nighttime hours controlling for gender and body mass index. RESULTS: The level of dietary caffeine was positively associated with daytime systolic BP (F(2,76) = 3.1, P = .05, partial R(2) = 0.07) and daytime diastolic BP (F = 3.53(2,76), P = .03, partial R(2) = 0.07). Caffeine's effect on systolic BP was most pronounced for African-American subjects. These results replicated our earlier findings. There was no association between caffeine intake and nighttime BP. CONCLUSIONS: This investigation replicates and extends our previous findings that caffeine consumption impacts the BP of adolescents, during the daytime when sympathetic nervous system responses dominate BP control. Controlled studies that examine the pressor effects of caffeine intake at levels typical of the dietary patterns of today's adolescents are needed.     

Food habits are related to glycemic control among people with type 2 diabetes mellitus

OBJECTIVE: To investigate the food habits of people with type 2 diabetes and to identify those habits related to glycemic control. DESIGN: The purposive sampling plan targeted people (40 to 65 years old) living in two urban communities in the Southeastern United States with type 2 diabetes for >1 year (60% women, 50% African Americans and low-income individuals). In-depth interviews were used to identify food habits. Glycated hemoglobin (HbA(1c)) was measured to assess glycemic control. SUBJECTS: The final sample contained 89 participants (62% women, 48% African American, and 43% below 200% of the poverty level). STATISTICAL ANALYSES PERFORMED: Analysis of variance, principal component/factor analysis, cluster analysis, and multiple regression were used to relate food habits to glycemic control. RESULTS: A four-factor solution derived from 15 food habits explained 51.5% of the total variance in HbA(1c) values. High factor scores for three factors (Basic Eating Practices, Meal Planning, and Carbohydrate/Vegetable Strategies) and low factor scores for a fourth factor (Challenges of Dining Out) were related to lower HbA(1c) values. Based on similar patterns across the 15 food habits, participants were clustered into four groupings. The clusters differing on HbA(1c) (mean+/-standard deviation) were Healthful Eating Lifestyle (6.25+/-0.25), Disciplined Eating Approach (7.31+/-0.35), Limited Dietary Focus (8.28+/-0.33), and Poor Dietary Management (9.05+/-0.24). These groupings reflected different food habit factor profiles. CONCLUSIONS: Knowledge of the specific food habits of people with diabetes can offer a way to structure a meaningful dialog with clients about dietary self-management and guide the collaborative development of relevant dietary goals.     

Cisplatin-induced apoptosis in auditory cells: role of death receptor and mitochondrial pathways

Cisplatin, a commonly used chemotherapeutic agent, has a major limitation due to its ototoxicity. Previous studies have shown that cisplatin induces apoptosis in auditory sensory cells, but the underlying mechanisms remain to be elucidated. In this study, cisplatin was found to induce apoptosis in a cochlear cell line, in a dose- and duration-dependent manner. Specific caspase assays revealed an early (6 h) but transient increase in caspase 8 activity, and a delayed (12 h) increase in caspase 9 activity. The enhanced caspase 8 activity was preceded by upregulation of p53 expression, and coincided with cleavage of Bid to its truncated form. This was followed temporally by activation and mitochondrial translocation of Bax, induction of mitochondrial permeability transition, release of cytochrome c into the cytosol, activation of caspase 9, and entry into the execution phase of apoptosis. Our results indicate the involvement of both the death receptor mechanisms as well as mitochondrial pathways in cisplatin-induced apoptosis of auditory cells in an in vitro model system.     

The right paratracheal stripe in children

The width of the right paratracheal stripe (RPS) has been established in normal adults but not in normal children. The thymus and great vessels are relatively larger in children than in adults and could obscure or widen the RPS. We found that obscuration does occur and, therefore, the RPS is less often measurable in children than in adults. Widening by the thymus and great vessels, however, does not occur. The width of the RPS in normal children, 0.5 to 3.0 mm, is slightly less than in adults. From this study of normal children and our subsequent experience with pediatric patients, we conclude that in a child an RPS 4 mm or wider is reliable evidence of disease affecting the trachea, mediastinum, or pleura.Supported, in part, by National Institutes of Health Training Grant GM 0/272 from the National Institute of General Medical Sciences