Rectal perforation as a complication of urethral instrumentation: 2 case reports

A review of the complications of urethral instrumentation performed at our institution during the last 15 years revealed 2 cases of urethrorectal perforation. These patients were managed with loop colostomy and suprapubic cystostomy diversion with excellent healing and no evidence of fistula formation at 24-month followup. This rare complication is described and the principles of diagnosis, prevention and prompt aggressive management are emphasized.     

Caring for elderly people at home: the consequences to caregivers

The emphasis on home-based care is one important aspect of health services restructuring initiatives in Canada. Fundamental to the preference for home-based care over institutional care is the expectation that family caregivers will be available in the home to support patients who would otherwise be in an institution. The authors explore the potential impact of this devolution of services from institutions to the home in 2 vulnerable patient populations--elderly patients with dementia and elderly patients with terminal illnesses. Community-based surveillance strategies are needed to determine the true health, quality-of-life and economic outcomes of these restructuring initiatives.     

Man the risk taker

Most approaches to preventing chronic disease involve changing personal behavior. Appeals to change are often made on the grounds that certain behavior incurs a risk to health, but evaluative studies of health education suggest that this may not be a persuasive argument. Humans have always lived with risks and do not necessarily equate risk with personal danger. Many forces, both social and psychological, underlie the willingness to tolerate risks, and altering familiar behaviors may seem to the individual to be more of a loss than a benefit. If we seek to change health behavior, we must acknowledge this and recognize that factual information on risks will not encourage change unless the change forms part of a broader reappraisal of the person's values. Individual appeals for change will have little impact as long as broader social forces continue to encourage health risk behavior.     

A case of dark urine,hyperpigmentation and hepatomegaly

We report a case of malignant melanoma in which the presenting feature was melanuria. Melanuria should be considered in the differential diagnosis of any patient presenting with dark urine.     

Body piercing: issues in adolescent health.

Ask the Expert provides research‐based answers to practice questions submitted by JSPN readers.     

Generation and comparative analysis of approximately 3.3 Mb of mouse genomic sequence orthologous to the region of human chromosome 7q11.23 implicated in Williams syndrome.

Williams syndrome is a complex developmental disorder that results from the heterozygous deletion of a approximately 1.6-Mb segment of human chromosome 7q11.23. These deletions are mediated by large (approximately 300 kb) duplicated blocks of DNA of near-identical sequence. Previously, we showed that the orthologous region of the mouse genome is devoid of such duplicated segments. Here, we extend our studies to include the generation of approximately 3.3 Mb of genomic sequence from the mouse Williams syndrome region, of which just over 1.4 Mb is finished to high accuracy. Comparative analyses of the mouse and human sequences within and immediately flanking the interval commonly deleted in Williams syndrome have facilitated the identification of nine previously unreported genes, provided detailed sequence-based information regarding 30 genes residing in the region, and revealed a number of potentially interesting conserved noncoding sequences. Finally, to facilitate comparative sequence analysis, we implemented several enhancements to the program, including the addition of links from annotated features within a generated percent-identity plot to specific records in public databases. Taken together, the results reported here provide an important comparative sequence resource that should catalyze additional studies of Williams syndrome, including those that aim to characterize genes within the commonly deleted interval and to develop mouse models of the disorder.     

Analysis of the OspE determinants involved in binding of factor H and OspE-targeting antibodies elicited during Borrelia burgdorferi infection in mice

Immune evasion by Lyme spirochetes is a multifactorial process involving numerous mechanisms. The OspE protein family undergoes antigenic variation during infection and binds factor H (fH) and possibly FHL-1/reconectin. In Borrelia burgdorferi B31MI, the OspE family consists of three paralogs: BBL39 (ErpA), BBP38, and BBN38 (ErpP). BBL39 and BBP38 are identical and therefore are referred to here as BBL39. The goals of this study were to assess the specificity of the antibody (Ab) response to the OspE paralogs and to identify the domains or determinants of OspE that are required for the binding of fH and OspE-targeting Abs that develop during infection. Here we demonstrate that at least some of the anti-OspE Abs produced during infection are paralog specific and that Ab binding requires conformational determinants whose formation requires both the N- and C-terminal domains of OspE. The binding of fH to OspE was also found to be dependent on conformational determinants. It is also demonstrated here that all of the OspE paralogs expressed by B. burgdorferi B31MI are capable of binding fH. The binding of fH to members of the OspF protein family was also assessed. In contrast to an earlier report, no binding of BBO39 or BBR42 to human fH was detected. Lastly, a series of competitive binding enzyme-linked immunosorbent assay analyses, designed to determine if fH and infection serum Abs bind to the same sites on OspE, revealed that these ligands interact with different regions of OspE.