The name of the game is change. Fred Hutchinson Cancer Research Center's clinical nutrition department is ahead of the game. Interview by Deborah Shattuck.
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Ambulatory Care↗
Biomedical subjects
J Stern
Publications and source records attributed to J Stern.
Malignant transformation of nasopharyngeal lymphoid hyperplasia.
Lymphadenopathy and nasal obstruction are very common in the HIV-positive patient and may or may not reveal a nasopharyngeal tumor. Biopsy is warranted if there is evidence suggestive of lymphoma or other neoplastic disease. This would include progressive rapid enlargement observed on examination or CT scan, an asymmetric growth pattern, and evidence of invasion of normal anatomic boundaries. It is certain that not all cases of adenoid hypertrophy that occurs early in the course of HIV disease represent a malignancy. Further study is needed to determine the proper timing for nasopharyngeal biopsy in the HIV-positive population. As the life span of the HIV-positive patient increases, so may the incidence of malignant degeneration.
Adenoids↗
[Incontinence after ileo-anal pouch anastomosis--diagnostic criteria and therapeutic sequelae].
After ileo-pouch-anal anastomosis (IPAA) there is an increased risk of incontinence due to intraoperative damage of the anal sphincter. We present a new concept to identify a potential incontinence prior to the closure of ileostomy by clinical and anal manometrical examinations. In 11 of 121 (9.1%) patients we diagnosed a potential incontinence. By biofeedback training we could achieve in this way a sufficient continence after the closure of ileostomy. After an average of 5.0 +/- 4.3 months of training rest pressures improved from 19.3 +/- 2.1 mmHg to 33.0 +/- 3.5 mmHg and squeeze pressures from 60.5 +/- 27.7 mmHg to 93.5 +/- 17.3 mmHg. Prior to IPAA patients with potential incontinence show significantly reduced rest pressures of 51.0 +/- 18.4 mmHg.
Adenomatous Polyposis Coli↗
Protein growth factors as potential therapies for central nervous system demyelinative disorders.
Demyelinative diseases are frequently accompanied by loss of oligodendroglia; in such instances, oligodendroglial regeneration must precede remyelination. Recent studies indicate that extracellular proteins such as platelet-derived growth factor (PDGF) and basic fibroblast growth factor (bFGF) profoundly influence the oligodendroglial lineage. PDGF stimulates the formation of oligodendroglia from partially differentiated progenitor cells, whereas bFGF induces mature oligodendroglia to proliferate and dedifferentiate. Manipulations of the central nervous system concentrations of these and other protein growth factors may prove of therapeutic value in multiple sclerosis.
Adult↗
Foscarnet: a possible cause of ulnar artery thrombosis in a patient with AIDS.
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Acquired Immunodeficiency Syndrome↗
Health during prolonged use of levonorgestrel 20 micrograms/d and the copper TCu 380Ag intrauterine contraceptive devices: a multicenter study. International Committee for Contraception Research (ICCR).
OBJECTIVES: To measure and compare the incidence of adverse events during use of two medicated intrauterine devices (IUDs). DESIGN: A multicenter prospective 7-year randomized study. SETTING: Family planning clinics, primarily in developing countries. SUBJECTS: Women age 18 to 38 years at admission, desiring contraception and without contraindications to IUDs. MAIN OUTCOME MEASURES: Incidence of complaints, conditions, and rates of specific termination for each IUD. METHODS: Subjects recorded menstrual events, and clinical staff registered all complaints and conditions found on examination at four first-year clinic visits and at semiannual visits thereafter. Difference in rates were analyzed by chi 2 statistics. RESULTS: Annual pregnancy rates for each IUD averaged 0.2/100 women whereas upper genital tract infection occurred at rates of 0.6 to 0.7 per 100 years of use. The levonorgestrel-releasing IUD significantly decreased bleeding and spotting days in comparison with historical data for noncontraceptors and with the copper-medicated IUD. Dysmenorrhea, vaginitis, and myoma in women with the levonorgestrel IUD were markedly decreased in comparison with the experience of copper IUD users. Significantly higher rates of amenorrhea, delayed ovarian follicular atresia, skin and hair conditions, and headache were observed with the steroid IUD than with the copper-releasing IUD. Rates of reported adverse effects for either IUD were highest in the first 2 years of use and among women under age 25. CONCLUSIONS: Long-term use of copper or levonorgestrel IUDs is characterized by very low rates of pregnancy and by a low and declining annual incidence of side effects, including pelvic infection and borderline anemia. The levonorgestrel-releasing IUD reduced the incidence of bleeding and, in the long term, of myoma and myoma-related surgery in comparison with the copper T IUD. Both IUDs proved highly acceptable and had few unanticipated side effects.
Adolescent↗
Interrelationships of leucine and glutamate metabolism in cultured astrocytes.
The aim was to study the extent to which leucine furnishes alpha-NH2 groups for glutamate synthesis via branched-chain amino acid aminotransferase. The transfer of N from leucine to glutamate was determined by incubating astrocytes in a medium containing [15N]leucine and 15 unlabeled amino acids; isotopic abundance was measured with gas chromatography-mass spectrometry. The ratio of labeling in both [15N]glutamate/[15N]leucine and [2-15N]glutamine/[15N]leucine suggested that at least one-fifth of all glutamate N had been derived from leucine nitrogen. At the same time, enrichment in [15N]leucine declined, reflecting dilution of the 15N label by the unlabeled amino acids that were in the medium. Isotopic abundance in [15N]isoleucine increased very quickly, suggesting the rapidity of transamination between these amino acids. The appearance of 15N in valine was more gradual. Measurement of branched-chain amino acid transaminase showed that the reaction from leucine to glutamate was approximately six times more active than from glutamate to leucine (8.72 vs. 1.46 nmol/min/mg of protein). However, when the medium was supplemented with alpha-ketoisocaproate (1 mM), the ketoacid of leucine, the reaction readily ran in the "reverse" direction and intraastrocytic [glutamate] was reduced by approximately 50% in only 5 min. Extracellular concentrations of alpha-ketoisocaproate as low as 0.05 mM significantly lowered intracellular [glutamate]. The relative efficiency of branched-chain amino acid transamination was studied by incubating astrocytes with 15 unlabeled amino acids (0.1 mM each) and [15N]glutamate. After 45 min, the most highly labeled amino acid was [15N]alanine, which was closely followed by [15N]leucine and [15N]isoleucine. Relatively little 15N was detected in any other amino acids, except for [15N]serine. The transamination of leucine was approximately 17 times greater than the rate of [1-14C]leucine oxidation. These data indicate that leucine is a major source of glutamate nitrogen. Conversely, reamination of alpha-ketoisocaproate, the ketoacid of leucine, affords a mechanism for the temporary "buffering" of intracellular glutamate.
Amination↗
Inhibition of astrocyte glutamine production by alpha-ketoisocaproic acid.
We have evaluated the effect of alpha-ketoisocaproic acid (KIC), the ketoacid of leucine, on the production of glutamine by cultured astrocytes. We used 15NH4Cl as a metabolic tracer to measure the production of both [5-15N]glutamine, reflecting amidation of glutamate via glutamine synthetase, and [2-15N]glutamine, representing the reductive amination of 2-oxoglutarate via glutamate dehydrogenase and subsequent conversion of [15N]glutamate to [2-15N]glutamine. Addition of KIC (1 mM) to the medium diminished the production of [5-15N]glutamine and stimulated the formation of [2-15N]glutamine with the overall result being a significant inhibition of net glutamine synthesis. An external KIC concentration as low as 0.06 mM inhibited synthesis of [5-15N]glutamine and a level as low as 0.13 mM enhanced labeling (atom% excess) of [2-15N]glutamine. Higher concentrations of KIC in the medium had correspondingly larger effects. The presence of KIC in the medium did not affect flux through glutaminase, which was measured using [2-15N]glutamine as a tracer. Nor did KIC inhibit the activity of glutamine synthetase that was purified from sheep brain. Addition of KIC to the medium caused no increased release of lactate dehydrogenase from the astrocytes, suggesting that the ketoacid was not toxic to the cells. KIC treatment was associated with an approximately twofold increase in the formation of 14CO2 from [U-14C]glutamate, indicating that transamination of glutamate with KIC increases intraastrocytic alpha-ketoglutarate, which is oxidized in the tricarboxylic acid cycle. KIC inhibited glutamine synthesis more than any other ketoacid tested, with the exception of hydroxypyruvate.(ABSTRACT TRUNCATED AT 250 WORDS)
Ammonium Chloride↗
Bilineal transmission in Tourette's syndrome families.
We assessed the frequency of bilineal (from maternal and paternal sides) transmission of Tourette's syndrome (TS) in two groups of pedigrees: (1) 39 high-density families in which five or more relatives were reported to have TS, and (2) the families of 39 consecutively ascertained probands referred for evaluation of TS. We used two designations for the TS phenotype (tics, tics or obsessive-compulsive behavior [OCB]), and we attempted to verify bilineal transmission with direct examinations. For the high-density pedigrees, bilineal transmission was evident in 33% (considering tics) and 41% (considering tics or OCB) of families, which was confirmed by examination in 77% of the kindreds. For the consecutive pedigrees, bilineal transmission was seen in 15% (tics) and 26% (tics or OCB) of families, which was verified by examination in 66% of the kindreds. Both parents of the proband were affected (tics or OCB) in 38% of the high-density pedigrees and 10% of the consecutive pedigrees. For the high-density families only, the frequency of bilineal transmission appeared to be related to the proband's severity of TS, and for both pedigree groups, the frequency of both parents being affected was higher in families in which the proband's symptoms were most severe. Our findings support the contention that bilineal transmission and homozygosity are common in TS. These genetic phenomena might play a role in determining severity of illness and may explain current difficulties in localizing the gene defect by linkage analysis.
Fathers↗
[Technique and results of the ileoanal pouch after proctocolectomy].
Nowadays restorative proctocolectomy and ileal pouch-anal anastomosis represent the standard procedure in the treatment for ulcerative colitis and familial polyposis. Although various pouchdesigns are described, the J-pouch is the one most frequently used. This study reviewed 311 operations of restorative proctocolectomy and ileal pouch-anal anastomosis between January 82 and December 93. The indication was ulcerative colitis in 234 and familial polyposis in 77 cases. In 67% of the cases the standard two-stage procedure involving secondary ileostomy closure was chosen. Due to the complex nature of the operation, postoperative morbidity--which is higher for ulcerative colitis--must not be undermined. Complete exstirpation of the pouch was required in 4.2% of the patients with ulcerative colitis and in one case with familial polyposis. In 12.4% and 1.3% a severe pouchitis was found in ulcerative colitis and familial polyposis respectively. In general postoperative functional results were satisfactory. Continence was established in over 90% of the patients while the mean stool frequency was 6 per day.
Adenomatous Polyposis Coli↗
What pi - pi scattering tells us about chiral perturbation theory.
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Journal Article↗
Subacute combined degeneration with high serum vitamin B12 level and abnormal vitamin B12 binding protein. New cause of an old syndrome.
Subacute combined degeneration of the spinal cord due to vitamin B12 deficiency invariably has been associated with a low serum vitamin B12 level. We describe a young man who presented with a unique syndrome of subacute combined degeneration associated with high serum vitamin B12 level, low red blood cell vitamin B12 level, and an abnormal plasma vitamin B12-binding protein. Uptake of cobalamin by his leukocytes in vitro was inhibited by his own but not by normal control plasma. Intensive hydroxocobalamin (vitamin B12) treatment was associated with clinical and electrophysiologic recovery accompanied by normalization of mean corpuscular volume, red blood cell vitamin B12 level, plasma homocysteine, and urinary methylmalonic acid. The subacute combined degeneration was probably precipitated by treatment with folic acid as the significance of his high serum vitamin B12 level was not apparent when he first presented with megaloblastic anemia 3 years earlier. To our knowledge, this is the first example of neurologic disease associated with high serum vitamin B12 level and provides further evidence that sometimes a serum vitamin B12 level may not be a reliable guide to vitamin B12 deficiency.
Adult↗
Trial of antihypertensive intervention and management: greater efficacy with weight reduction than with a sodium-potassium intervention.
The Trial of Antihypertensive Intervention and Management evaluated nine diet-drug combinations in 878 mildly hypertensive, moderately obese participants using a 3 x 3 factorial design. Drugs evaluated were placebo, diuretic (chlorthalidone), and beta-blocker (atenolol); diets were usual (no intervention), weight reduction, and low sodium/high potassium (Na/K). This article reports 6-month dietary changes and the effect of dietary change on blood pressure. Six-month mean weight change was -4.7 kg in the weight reduction group, -0.3 kg in the Na/K group, and -0.5 kg in the usual-diet group. At 6 months, daily electrolyte excretion had changed in the Na/K intervention group. Daily sodium excretion decreased from 138.0 to 112.0 mmol in the Na/K group and increased from 134.1 to 138.4 mmol in the weight reduction group and from 129.1 to 137.0 mmol in the usual-diet group. Daily potassium output increased from 58.7 to 71.4 mmol in the Na/K group, from 57.0 to 60.5 mmol in the weight reduction group, and from 55.3 to 59.1 mmol in the usual diet group. Analysis of 3-day food records indicated that sodium intake decreased from 141.1 to 85.8 mmol and potassium intake increased from 76.4 to 90.5 mmol. Our results indicate that the goal for weight reduction was more easily achieved than the goal for electrolyte modification.
Adult↗
Four-year experience in a randomized study of the Gyne T 380 Slimline and the Standard Gyne T 380 intrauterine copper devices.
Performance of the Slimline and Standard models of the Gyne T 380 were measured through four years in a comparative study initially involving 996 women, seventy percent of whom were randomized to the Slimline device. Cumulative pregnancy rates of Slimline users were 0.3 +/- 0.2 per 100 both at three and at four years, as compared with rates of 1.5 +/- 0.9 and 3.8 +/- 1.7 at the same intervals for users of the Standard model (P > .05). The four-year explusion rate of the Slimline, 8.6 +/- 1.3 per 100, was significantly higher than the comparable rate of the Standard model, 4.4 +/- 1.6 (P < .05). The two Gyne T* models did not differ in continuation rates. First time IUD users, however, had substantially lower continuation rates than did former users (P < .001), in consequence of their relative youth and desire to have additional children. Other performance measures did not differ importantly by device.
Adolescent↗
Extracorporeal shock wave lithotripsy for calcified ureteral stent.
Calcification of a ureteral stent has been an unusual complication of long-term stent use for bypassing ureteral obstruction or after surgical repair. Open or percutaneous procedures have usually been required to remove the calcification before the stent can be extracted. We report six cases of calcified ureteral stents successfully managed by extracorporeal shock wave lithotripsy (SWL) followed by cystoscopic extraction, thus avoiding open or percutaneous procedures.
Adult↗
Attitudes of British psychiatrists to the diagnosis of somatisation disorder. A questionnaire survey.
A postal questionnaire was sent to 195 senior British psychiatrists who were asked about their attitudes towards the DSM-III-R diagnosis of somatisation disorder (SD) and the ICD-10 diagnosis of multiple somatisation disorder. Of the 148 respondents, 98 (66%) had experience of liaison psychiatry, and these psychiatrists used the diagnosis significantly more often than those without liaison sessions. More than half the respondents perceived SD as both a personality disorder and a mental state disorder, although 27% thought that patients with SD had an undiagnosed physical disease. The marked discrepancy between British and North American psychiatrists in diagnostic practices was perceived to be a consequence of both the difference in health care systems and the interest shown in the disorder by North American psychiatrists, rather than a reflection of genuine differences in prevalence.
Attitude of Health Personnel↗
Personality disorders in patients with somatisation disorder. A controlled study.
Twenty-five women with somatisation disorder (SD) were compared with matched patient controls for the presence of personality disorders. Personality was assessed with the Personality Assessment Schedule (PAS). Interviewers were unaware of the patients' diagnoses. All controls had DSM-III-R axis I diagnoses of depressive or anxiety disorders. The prevalence of personality disorders among patients with somatisation disorder was 72% compared with 36% among controls. Certain personality disorders, including passive-dependent, histrionic, and sensitive-aggressive, occurred significantly more often in the SD patients than controls.
Adult↗
[Continence preserving operation after proctocolectomy. Indications, technique and results].
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Adenomatous Polyposis Coli↗