Treatment of hemorrhagic congestive gastropathy with TIPS implantation. Pilot study

OBJECTIVE: taking evidence provided by an ethnographic study based on women's experiences of pregnancy and childbirth, and using ritual theory in the analysis of the relationship between the medical metaphor, inherent in contemporary birth settings, and the views and expectations of childbirth which the women bring with them to that setting. DESIGN: small scale qualitative study using ethnographic research techniques. SETTING: GP surgeries, two consultant-led, hospital-based antenatal units, labour suites and postnatal wards, plus the homes of the women involved from the north east of England. PARTICIPANTS: 40 primigravid women providing two sample groups. Half of the women were actively involved in antenatal class programmes run by the National Childbirth Trust and the NHS and the other half did not attend any antenatal classes. MAIN FINDINGS: within the sample there was a clear cultural diversity which carried significant implications on how the women assembled their understanding of pregnancy and birth antenatally. However, this division lost clarity at the onset of labour, rendering delivery experiences more similar than might have been expected. Ritual theory offers significant insight into this phenomenon, analysing birth as a rite of passage provided a necessary tool to explain why this pattern emerged in the data. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: cultural diversity suggests an element of caution should be used when advocating the notion of 'informed choice' across the board, sensitivity to existing cultural values is imperative. Despite an emphasis on informed choice, midwifery practice continues to offer the medical metaphor as the dominant cultural prop in the labour ward.     

Prevalence and impact of risk factors for lower body difficulty among Mexican Americans, African Americans, and whites

BACKGROUND: The purpose of the study was to estimate the prevalence of sociodemographic, health behavior, chronic disease, and impairment factors and their impact on difficulty in lower body function among two age-cohorts (51-61 and 71-81 years) of Mexican Americans, African Americans, and Whites. METHODS: Reports from 8,727 and 4,510 self-respondents of the 1992 baseline Health and Retirement Survey and the 1993 baseline Assets and Health Dynamics Study, respectively, were used to estimate prevalence. Multiple linear regression of the 4-item lower body difficulty scale (alpha = .80) was used to estimate the direct effects of the risk factors within the age-cohort and ethnicity groups. RESULTS: Overall, the risk factors are more prevalent among both minority groups and the older age-cohort. Lower body deficits are particularly high among Mexican Americans and the younger age-cohort of African Americans. The impact of risk factors does not vary much by ethnicity or age-cohort. Female gender, pain, arthritis, and heart and lung disease are the major risk factors, and they account for about one-third of the variance in lower body difficulty for each group. CONCLUSIONS: Efforts to prevent or reduce lower body difficulty should pay particular attention to pain, arthritis, and heart and lung disease. The central role of sociodemographic and behavioral factors in chronic disease argues for their continued inclusion in disability modeling and prevention.     

Effect of sucralfate and basic fibroblast growth factor on fibrovascular ingrowth into hydroxyapatite and porous polyethylene alloplastic implants using a novel rabbit model

This study investigated the effects of sucralfate and basic fibroblast growth factor (bFGF) on fibrovascular ingrowth into porous implant materials. Seven white female New Zealand rabbits underwent bilateral abdominal incisions through which porous orbital spherical or and disc-shaped implants were inserted between their abdominal muscles. Eighty hydroxyapatite (HA) and porous polyethylene (PP) implants, each material of different pore sizes, were implanted. These implants were either uncoated or coated with suspensions of polyhydroxymethylmethacrylate (hydron); hydron and sucralfate; or hydron, sucralfate, and bFGF. Implants were harvested after 1, 3, or 6 weeks. Observers classified the extent of fibrovascular ingrowth in a blind manner using light microscopy. All discs and spheres showed fibrovascular ingrowth; at 6 weeks, almost all implants were fully vascularized. Although demonstrating different degrees of fibrovascular maturity, all 3- and 6-week discs showed complete cellular ingrowth. Overall, the most extensive and mature fibrovascularization was found in HA implants, regardless of shape, duration of implantation, or angiogenic enhancing agent used. Thus, this study indicates that fibrovascular ingrowth into porous implants is more greatly affected by implant porosity and composition than by addition of angiogenic enhancing agents. Further in vivo study, using other potential angiogenesis-promoting agents as well as implants with different pore characteristics, is warranted using this reliable and predictable animal model.     

The effect of age on risk factors for ischemic heart disease: the Manitoba Follow-Up Study, 1948-1993

PURPOSE: The purpose of this paper is to determine the age-specific relationships between risk factors at age 40 through 75 years and ischemic heart disease (IHD), and to determine the effects of aging on these relationships in a cohort of 3983 Canadian males. METHODS: The Manitoba Follow-Up Study is the prospective investigation of cardiovascular disease as it develops in a cohort of 3983 young men. Over a period of 45 years, from 1948 to 1993, 1094 study members (27%) developed clinical evidence of IHD. Blood pressure, body weight, smoking, and presence of diabetes mellitus have been recorded at regular intervals throughout the follow-up period. Using measurements from examinations every 5 years between ages 40 and 75 years, age-specific Cox proportional hazard models were fit to relate these risk factors to IHD. RESULTS: The adjusted relative risk of IHD for systolic blood pressure, diastolic blood pressure and smoking were found to significantly (p < 0.001) decline with advancing age. The adjusted relative risk for body mass index and presence of diabetes mellitus for ischemic heart disease did not vary with age (p > 0.05). After age 65 years, these risk factors were of little value for the prediction of IHD. CONCLUSIONS: The relative risk and statistical significance of blood pressure and smoking, as risk factors for IHD, decline with age.     

Alterations in dopamine release but not dopamine autoreceptor function in dopamine D3 receptor mutant mice

Dopamine (DA) autoreceptors expressed along the somatodendritic extent of midbrain DA neurons modulate impulse activity, whereas those expressed at DA nerve terminals regulate both DA synthesis and release. Considerable evidence has indicated that these DA autoreceptors are of the D2 subtype of DA receptors. However, many pharmacological studies have suggested an autoreceptor role for the DA D3 receptor. This possibility was tested with mice lacking the D3 receptor as a result of gene targeting. The basal firing rates of DA neurons within both the substantia nigra and ventral tegmental area were not different in D3 receptor mutant and wild-type mice. The putative D3 receptor-selective agonist R(+)-trans-3,4,4a, 10b-tetrahydro-4-propyl-2H,5H-(1)benzopyrano(4,3-b)-1,4-oxazin+ ++-9-ol (PD 128907) was equipotent at inhibiting the activity of both populations of midbrain DA neurons in the two groups of mice. In the gamma-butyrolactone (GBL) model of DA autoreceptor function, mutant and wild-type mice were identical with respect to striatal DA synthesis and its suppression by PD 128907. In vivo microdialysis studies of DA release in ventral striatum revealed higher basal levels of extracellular DA in mutant mice but similar inhibitory effects of PD 128907 in mutant and wild-type mice. These results suggest that the effects of PD 128907 on dopamine cell function reflect stimulation of D2 as opposed to D3 receptors. Although D3 receptors do not seem to be significantly involved in DA autoreceptor function, they may participate in postsynaptically activated short-loop feedback modulation of DA release.     

Prevalence of sudden cardiac death during competitive sports activities in Minnesota high school athletes

OBJECTIVES: Reliable prevalence data would be useful in assessing the impact of sudden cardiac death in young competitive athletes on the community and designing effective preparticipation screening strategies. BACKGROUND: The frequency with which these catastrophes occur is largely unknown. METHODS: We utilized a circumstance unique to Minnesota in which the precise number of participants and deaths due to cardiovascular disease could be ascertained over a substantial period of time based on a long-standing insurance program for catastrophic injury or death, mandatory for all student athletes engaged in interscholastic sports. RESULTS: Over the 12-year period, 1985/1986 to 1996/1997, inclusive, three sudden deaths due to cardiovascular disease occurred in competitive high school athletes (grades 10-12) during competition or practice. At autopsy, 1 each proved to be due to anomalous origin of the left main coronary artery from the right sinus of Valsalva, congenital aortic valve stenosis (with bicuspid valve) and myocarditis. All three athletes were white and male, 16 or 17 years of age; two competed in cross-country/track and one in basketball. During the study period there were 1,453,280 overall sports participations and 651,695 student athlete participants among the 27 high school sports. The calculated risk for sudden death was 1:500,000 participations and 1:217,400 participants per academic year (or 0.46/100,000, annually). Over a 3-year high school career for a student athlete the estimated risk was 1:72,500. CONCLUSIONS: The risk of sudden cardiac death in a population of high school student athletes was small, in the range of one in 200,000 per year, and was higher in male athletes. The rare occurrence of sudden cardiac death in competitive sports underlines the limitations implicit in structuring productive and cost-effective broad-based preparticipation screening strategies for high school athletes.     

The relationship between hepatitis C virus and schistosomiasis: histopathologic evaluation of liver biopsy specimens

The reported high incidence of anti-HCV seropositivity in the Egyptian population seems surprising. Some suggest that schistosomiasis is the responsible factor, either by producing false positivity for HCV antibodies or by predisposing to actual HCV infection in some way. In an attempt to investigate this unclear relationship on a histological level, we performed a thorough semiquantitative morphological study of liver biopsy specimens from 44 anti-HCV-positive Egyptian patients with chronic liver disease. More than half of these patients (23) had serological evidence of schistosomiasis. The results have shown that all 44 liver biopsy specimens demonstrated the histopathological features known to be characteristic of chronic HCV hepatitis. Statistical analysis showed no significant difference between the schistosomal and nonschistosomal groups regarding the semiquantitative histological scores of these features. This study confirms the presence of definite HCV-induced hepatic pathology in all anti-HCV seropositive cases. More importantly, it shows the lack of enhancement of this pathology in the schistosomal patients.     

Does type of colostomy influence outcome of colostomy closure?

A retrospective analysis of 81 patients who had closure of colostomy over a 32-month period was carried out to establish factors affecting the outcome of this operation. Their ages averaged 27 years and there were 69 male patients. The sigmoid colon was the most common site and the loop colostomy was most frequently performed. The majority were closed 3 or more months after construction. Loop colostomy took significantly less time to close and patients were fed significantly earlier compared with the other types. Patients who underwent closure after Hartmann's procedure had the longest hospital stay. The complication rate was 12% and there was no mortality. Colostomy closures in this study had minimal complications and no mortality. The loop colostomy is as easy to close as it is to perform and results in shorter hospital stay.     

Depressed heart rate variability and arterial baroreflex in conscious transgenic mice with overexpression of cardiac Gsalpha

Using a continuous recognition memory procedure for spatial location information, rats were given sequential presentation of individual arms on a 12-arm maze. Each arm contained a Froot Loop reinforcement the first time it was presented, and latency to traverse the arm was measured. A subset of the arms were repeated, but did not contain reinforcement. Repeated arms were presented with lags ranging from zero to six (from zero to six different arm presentations occurred between the first and repeated presentation). After completion of acquisition training (significantly longer latencies for repeated arms in comparison with the first presentation of an arm), rats received lesions of the medial or lateral entorhinal cortex, pre- and parasubiculum, or served as sham-operated controls. Based on continued postsurgery training and additional tests, the results indicated that rats with pre- and parasubiculum or pre- and parasubiculum plus medial entorhinal cortex produced sustained impairment in performing the task. Medial or lateral entorhinal cortex and control lesions did not display any sustained deficits. The data suggest that working memory for spatial location information is mediated primarily by the pre- and parasubiculum, but not medial entorhinal and lateral entorhinal cortex.