The cases of two patients with continent ileostomies are presented. These illustrate the problems encountered with detachment of the pouch from the abdominal wall resulting in angulation of the efferent loop of the pouch in relation to the nipple valve and difficulty intubating the pouch. Both patients required operative correction of the separation. Several suggestions are made in order to prevent or decrease the incidence of the complications. Removal of a peritoneal strip around the efferent loop of the pouch appears to facilitate adequate fixation of the pouch to the anterior abdominal wall.

Adult↗

PubMedDate not supplied

Functions of mammalian Smad genes as revealed by targeted gene disruption in mice.

The Smad genes are the intracellular mediators of TGF-beta signals. Targeted mutagenesis in mice has yielded valuable new insights into the functions of this important gene family. These experiments have shown that Smad2 and Smad4 are needed for gastrulation, Smad5 for angiogenesis, and Smad3 for establishment of the mucosal immune response and proper development of the skeleton. In addition, these experiments have shown us the importance of gene dosage in this family, as several of its members yielded haploinsufficiency phenotypes. These include gastrulation and craniofacial defects for Smad2, accelerated wound healing for Smad3, and the incidence of gastric cancer for Smad4. Combinatorial genetics has also revealed functions of Smads in left/right isomerism and liver development.

Animals↗

PubMedDate not supplied

Female fecundity in highland Papua New Guinea.

Demographers often assume that interpopulation variation in birth spacing is attributable primarily to behavioral differences (e.g., in breastfeeding, coital frequency, or contraceptive practice), and that the contribution of physiological factors is negligible. This assumption may be correct, but it should be tested, especially in light of recent evidence that there may be more variation in ovarian function among human populations than was previously believed. In this paper, we apply a stochastic model of the determinants of fecundability (the monthly probability of conception) to endocrinological data collected among the Gainj, a tribal population in highland Papua New Guinea. Based on previous research, the Gainj are known to have age patterns of ovarian function that differ markedly from the Western norms. When account is taken of the late menarche, early menopause, and long ovarian cycles that appear to characterize Gainj women, mean apparent fecundability across the female reproductive span is reduced by about 27 per cent (from 0.316 to 0.235), and the mean waiting time to next apparent conception is increased by just over one month. Thus, despite the fact that Gainj women differ from Western women with respect to reproductive physiology by as much as or more than any other known population, the demographic impact of these differences appears to be slight.

Birth Intervals↗

PubMedDate not supplied

How does variation in fetal loss affect the distribution of waiting times to conception?

Unmeasured variation has long been a concern in analyses of the waiting time to conception. Recent work by Heckman and Walker (1991) and Trussell and Rodriguez (1990) has underscored the fact that statistical considerations alone cannot discriminate among likely models describing the distribution. Here, we specify a single theoretically important source of heterogeneity, namely variability in intrauterine mortality, and assess its effects on the waiting times to a conception which results in a live birth. We find that the effects on the waiting times to a conception which results in a live birth. We find that the effects of variation in fetal loss are confined to the tail of the distribution. Unless variation in fetal loss is extremely large or a substantial proportion of observed waiting times are initiated at late ages, variation in fetal loss does not appear to explain much variation in conception waits. We conclude that heterogeneity in fetal loss does not explain the variation in fecundability that has been observed for first birth intervals. This conclusion supports the hypothesis that at early ages (below age 35) variation in the waiting time to a fertile conception may largely reflect the proportion of nonsusceptible couples in the population. The analyses suggest that for the purposes of testing theoretically motivated models, future efforts should be directed toward examining reproductive experience after age 35 and toward incorporating information on characteristics of the fertile period as it becomes known.

Abortion, Spontaneous↗

PubMedDate not supplied

Menarcheal age and subsequent patterns of family formation.

We examine whether age at menarche affects age at first marriage or first birth using two samples of U.S. women. Data are drawn from the Tremin Trust, a longitudinal study of menstrual cycles that recruited white women who were students at the University of Minnesota and from a survey of a nationally representative sample of white women born between 1900 and 1910. Regression models with cubic splines were used to analyze the relationship between age at menarche and age at first marriage. Cox proportional hazard models were used to examine the effect of age at menarche on the interval between marriage and first birth. Unlike earlier work, we found that once secular trends in both age at marriage and age at menarche were taken into account, there was no evidence that age at menarche affects either age at marriage or the timing of first births in these U.S. women.

Adolescent↗

PubMedDate not supplied

Penetration of cefoxitin into cerebrospinal fluid and treatment of meningitis caused by gram-negative bacteria.

Two patients with meningitis caused by antibiotic-resistant Escherichia coli and Klebsiella pneumoniae were treated successfully with intravenous cefoxitin plus oral probenecid. A total of 25 patients with central nervous system disorders that required a diagnostic spinal tap were also given cefoxitin, with or without probenecid, for determination of the degree of penetration into cerebrospinal fluid. In patients with uninflamed meninges, little or no cefoxitin entered after a single dose of 4-6 g. After three doses of 4 g each over a 6-8-hr period, penetration was considerable (average, 7% of the simultaneous serum level). In patients with inflamed meninges, a similar concentration was achieved rapidly after a single 2-g dose. After a day of therapy, cerebrospinal fluid levels equivalent to 30%-70% of the simultaneous serum levels were found; as the inflammation subsided, cerebrospinal fluid levels fell to around 15% of those in serum. Probenecid did not appear to influence greatly the degree of penetration.

Adolescent↗