Culture, adaptation, and patterns of disease

The sick patient, rather than the disease process itself, should occupy the central focus of the physician's attention. Such an approach recognizes the interaction of physiologic and emotional forces in the occurrence of disease. It allows for a consideration of the contributory role of emotions in the precipition of physical illness and a recognition that physical illness may produce emotional sequelae of relevance to the total clinical problem. It is an approach which views man as an adapting animal, whose environment may play a crucial role in his adaptation and his disease. Only with such a perspective of man and disease can the principles of medical treatment be realistic.     

Will PAPP-A be a biochemical marker for screening of Down''s syndrome in the first trimester?

In 1991, the National Tuberculosis Control Program could start in Madagascar, thanks to the financial support of the French Cooperation. Within 3 years, this allocation of resources allowed the management, respecting the new standards, of 56% of the country's health structures and of more than 75% of the sick. The number of detected and treated patients increased of 80%. During the same period, the recovery rate increased from less than 35% to more than 65%. Those primary results were satisfactory in terms of working but they were not enough in epidemiological terms as the aims were still far: the detection rate of smear-positive pulmonary tuberculosis was 40% whereas it ought be 60%, and their recovery rate was 65% whereas it ought to be over 80%. The geographic extension of the Program and its progress depend on a structural strengthening needing an obvious political will and on the intervention of financial partners cooperating with France and willing to set up a long lasting partnership.     

Gender differences in sexual desire: the effects of anger and anxiety

The effects of anxiety and anger on subjective sexual desire in men and women, following Kaplan's model of hypoactive desire disorders, were examined. Gender-appropriate erotic audiotapes containing statements designed to elicit anxiety, anger, or situationally appropriate feelings (control condition) were presented to 24 men and 24 women. Dependent measures included subjective anxiety and time to expressed desire to terminate the sexual encounter. Results indicated that, for women, both anger and anxiety significantly reduced desire relative to the control condition, with anger showing a more marked effect. For men, similar results were noted, although fewer differences were observed between the anxiety and anger conditions. Significantly more women (79%) than men (21%) indicated that they would have terminated the encounter during the anger condition. Results are discussed in light of potential gender differences in factors that influence sexual desire, with directions for future research highlighted.     

Outcome of wheeze in childhood: the influence of atopy

We have previously demonstrated that the adult outcome of childhood asthma differs from that of wheeze occurring only in the presence of infection. This paper examines the role of atopy in relation to outcome. We investigated the atopic status, current symptoms and bronchial reactivity to methacholine of 235 subjects aged 34-40 yrs, originally classified at age 10-15 yrs as having asthma (asthma group), wheeze only in the presence of infection (wheezy group), or no respiratory symptoms (comparison group). Subjects from the original asthma group were more likely to be atopic as defined by skin test reactivity, total serum immunoglobulin E (IgE) measurement or specific IgE radio allergosorbent test (RAST) measurement than those from the wheezy group. The wheezy group differed significantly from the reference group only in RAST results, when other variables were taken into account. In a logistic regression model, the important independent predictors for adult wheezing symptoms were original group, atopy and current smoking. Methacholine responsiveness was independently associated with original group (the asthma group were more likely to respond positively), atopy and female gender. The results suggest that atopy is an important predictor for wheeze and bronchial hyperreactivity in middle age. However, the difference in outcome for children who had asthma compared to those who had wheeze only in the presence of infection cannot be explained by atopy alone.     

Phosphatidylinositol transfer proteins: the long and winding road to physiological function

Murine gammaherpesvirus 68 (MHV-68) is a naturally occurring herpesvirus of wild rodents and is genetically related to human herpesvirus 8 and Epstein-Barr virus. The ability of MHV-68 to establish acute and persistent infection within laboratory mice offers a unique opportunity to investigate immunological and virological aspects of gammaherpesvirus pathogenesis.     

Procoagulant and proinflammatory activity in acute coronary syndromes

Free-living elderly people aged > or = 65 y were recruited to assess riboflavin and vitamin B-6 intakes and status and the effect of riboflavin supplementation on biochemical indicators of these 2 vitamins. The status of riboflavin (erythrocyte glutathione reductase activation coefficient; EGRAC) and vitamin B-6 (plasma pyridoxal-5'-phosphate; PLP) were determined in a total sample of 92 subjects, from whom dietary intake data were obtained by using the diet history method (n = 83). Although dietary intakes of both vitamins were considered to be adequate according to current reference values, abnormal EGRAC and plasma PLP values were identified in 49% and 38% of subjects, respectively, with 21% having suboptimal status for both nutrients. A subgroup of subjects from the initial sample (n = 45) was assigned in a double-blind manner to receive either 1.6 or 25 mg riboflavin or placebo daily for 12 wk. In those subjects with a baseline EGRAC or plasma PLP value falling outside the currently accepted threshold value for adequacy, low-dose riboflavin supplementation improved status of the limiting nutrient significantly (P<0.0001 and P = 0.020 for EGRAC and plasma PLP responses, respectively). We conclude that a high proportion of healthy elderly people may have suboptimal status for these nutrients despite apparently adequate dietary intakes. Furthermore, we showed that riboflavin supplementation at physiologic doses corrects biochemical abnormalities of not only EGRAC, but also plasma PLP, confirming the biochemical interdependency of these vitamins and suggesting that riboflavin is the limiting nutrient.     

Changing trends in the management of phaeochromocytoma

Sixty-one women making slow progress in the active phase of spontaneous labour with intact membranes were randomised to oxytocin and amniotomy, amniotomy only or expectant management. The data show that oxytocin significantly increases the rate of cervical dilatation and shortens prolonged labour, when compared with amniotomy alone and expectant management (P = 0.0144 and 0.0006, respectively). The impact on the operative delivery rate and neonatal outcome is difficult to assess due to the small number of relevant adverse outcomes. Women reported higher satisfaction score in the two groups where intervention followed the diagnosis of dysfunctional labour.     

Primary adenocarcinoma of the urethra with metastasis to the glans penis: successful treatment with chemotherapy and radiation therapy

The feasibility of catheter-directed thrombolysis with recombinant staphylokinase was evaluated in six selected patients with deep vein thrombosis. The patients underwent intrathrombus infusion of recombinant staphylokinase (2 mg bolus followed by a continuous infusion of 1 mg/h). Heparin was given via the catheter as a bolus (5000 U) and as a continuous infusion (1000 U/h). Complete lysis was obtained in five patients and partial lysis in one patient. Complications consisted of minor bleeding in four subjects. Symptomatic reocclusion occurred in one. Debulking of the thrombus mass by a high speed rotating impeller (n = 1) and stenting (n = 3) were used as additional interventions. An underlying anatomical abnormality was present in two patients. Long term follow up revealed normal patency in all patients and normal valve function in four patients. Symptomatic venous insufficiency with valve dysfunction was present in the two with a second thrombotic episode. Thus catheter-directed infusion of recombinant staphylokinase in patients with deep vein thrombosis appears feasible and may be associated with a high frequency of thrombolysis. Larger studies to define the clinical benefit of this treatment appear to be warranted.     

COI1: an Arabidopsis gene required for jasmonate-regulated defense and fertility

The coi1 mutation defines an Arabidopsis gene required for response to jasmonates, which regulate defense against insects and pathogens, wound healing, and pollen fertility. The wild-type allele, COI1, was mapped to a 90-kilobase genomic fragment and located by complementation of coi1-1 mutants. The predicted amino acid sequence of the COI1 protein contains 16 leucine-rich repeats and an F-box motif. It has similarity to the F-box proteins Arabidopsis TIR1, human Skp2, and yeast Grr1, which appear to function by targeting repressor proteins for removal by ubiquitination.