Symptomatic sulfadiazine crystalluria in AIDS patients: a report of two cases

In May 1993, the US Food and Drug Administration (FDA) granted product approval for the first female condom made of polyurethane. It provides some protection against sexually transmitted diseases (STDs), but the data are limited on the effectiveness of the Reality Vaginal Pouch against STDs. Female condom users have a relatively high pregnancy rate. FDA requires the label for Reality to stress that latex condoms for men are most effective against STDs and HIV/AIDS. Men who are sensitive to rubber can use condoms made of sheep intestine or cecum (brand names: Fourex and Lambskin). These nonrubber male condoms prevent pregnancy, but do not prevent HIV transmission. A specialist in contact dermatitis suggests that rubber sensitive men use a nonrubber condom directly over the penis and then cover that condom with a rubber condom to protect against HIV transmission. A nonlatex thermoplastic elastomer has been used to make male condoms since the early 1990s, but FDA has yet to approve it. A recent article suggests that a thermoplastic elastomer may be the only choice for rubber sensitive males. FDA approval will increase the availability of a nonlatex thermoplastic elastomer condom. The contact dermatitis specialist reviews and follows up on other articles he has written over the last 20 years. Topics include ethylene oxide burns in hospitalized patients, paraben paradox, benzocaine as a contaminant in sunscreens containing glyceryl PABA, sensitivity to nickel, misuse of a patch test to detect hypersensitivity to mercury amalgam dental fillings, permanent destruction of the fingernails due to an allergic reaction to an acrylic nail preparation, and dermatitis due to visual display units.     

Disparity in glycemic control and adherence between African-American and Caucasian youths with diabetes. Family and community contexts

OBJECTIVE: To describe sociodemographic, family, and community factors that contribute to the glycemic control of African-American and Caucasian youths with diabetes, we investigated two questions: 1) Is there a disparity in glycemic control between African-American and Caucasian youths with diabetes, and if so, what sociodemographic, family, and community factors explain the disparity? and 2) Is there a difference in the adherence to treatment between African-American and Caucasian youths with diabetes, and if so, what sociodemographic, family, and community factors explain the difference? RESEARCH DESIGN AND METHODS: This cross-sectional study included 146 youths with diabetes (95 Caucasians and 51 African-Americans) and their mothers. The youths were invited to participate if they had been diagnosed with diabetes at least 1 year before the study, did not have another chronic illness, and were < 18 years of age. RESULTS: The findings indicate that African-American youths with diabetes are in significantly poorer metabolic control than their Caucasian counterparts (1.5% difference in HbA1c levels). Single-parent household status and lower levels of adherence partially account for the poorer glycemic control. Examination of the adherence subscales indicates that African-Americans report significantly lower adherence to diet and glucose testing than Caucasian youths. CONCLUSIONS: This study suggests that African-American youths with diabetes may be at greater risk for poor glycemic control due to the higher prevalence of single parenting and lower levels of adherence found in this population.     

The effect of erythritol on the stability of gamma-glutamyl transpeptidase and N-acetyl glucosaminidase in human urine

In toxicology studies and clinical trials of erythritol, treated animals and human subjects had higher urine gamma-glutamyl transpeptidase [gamma-glutamyl transferase (gamma-GT)] than untreated controls. It has previously been reported that gamma-GT activity in frozen urine decreases with time; therefore, a study was undertaken to examine the effects of storage temperature, time, and the presence of erythritol on the stability of gamma-GT and N-acetyl glucosaminidase in human urine. In this study, it was found that the rate of decrease of the activity of gamma-GT is much greater at -20 degrees C than at -70 degrees C. Variation in the storage temperature of the frozen urine is particularly deleterious to gamma-GT. The addition of erythritol in a concentration of 5% reduces this decrease. Approximately 15% of N-acetyl glucosaminidase activity is lost in the initial process of freezing the urine. Thereafter, conditions of temperature, time, and the presence or absence of erythritol account for little additional loss of activity.     

Cooperative effects of p53 and pRB alterations in primary superficial bladder tumors

Altered patterns of p53 and pRB expression have been reported to be frequent events and to have prognostic significance in bladder cancer. To assess the potential adverse consequences of having altered patterns of both p53 and pRB proteins in patients with bladder neoplasms compared with having one or neither abnormality, we have studied a cohort of superficial transitional cell carcinomas of the urinary bladder by immunohistochemical analysis. The present study included 59 well-characterized superficial transitional cell carcinomas (Ta, n = 28; T1, n = 31) for which clinicopathological variables were available. Nuclear overexpression of p53 was identified in 22 cases (37%). A statistically significant association was observed between the p53-positive phenotype and disease progression (P < 0.001), as well as reduced survival (P < 0.001). Undetectable levels of pRB were observed in 11 cases (19%). Patients with a pRB-negative phenotype had a more frequent disease progression (P = 0.014) and decreased overall survival (P = 0.014). We also observed a significant association between altered p53 and undetectable pRB expression patterns (P = 0.001). Nine tumors showed both a p53-positive and a pRB-negative phenotype. There was an even more marked increase in progression (P = 0.00005) and decreased overall survival (P = 0.0004) in patients whose tumors had both alterations after controlling for tumor stage, tumor grade, and suspicion of vascular invasion. These data suggest that alterations of p53 and pRB have a cooperative negative effect on both progression and survival in primary bladder cancer. It may be postulated that aberrant p53 and pRB expression deregulates cell cycle control at the G1 checkpoint and engenders tumor cells with reduced response to programmed cell death. The imbalance produced by an enhanced proliferative activity and a decreased apoptotic rate may determine the aggressive clinical course of the bladder tumors harboring both p53 and pRB alterations.     

Short-term ozone exposure affects the surface activity of pulmonary surfactant

The effects of short-term ozone exposure on the lung function and surface activity of surfactant subtypes isolated from rat lung lavage were studied. Rats were exposed to 0.8 ppm ozone for 2 or 12 hr. The surface activity of surfactant was affected by ozone exposure, whereas distinct morphological changes in bronchoalveolar lavage or in the surfactant subtypes were not observed. Adsorption experiments indicated that bronchoalveolar lavage from rats exposed for 12 hr to ozone remained at lower equilibrium surface pressures than lavage from control rats. These observations suggest interference of inflammatory proteins with the surface film. Extracted surfactant, containing only lipids and surfactant proteins B and C, had a decreased adsorption rate after ozone exposure. These results suggest that the activity of one or both of the hydrophobic surfactant proteins (SP-B and SP-C) was affected by ozone.     

Identification of a histidine residue essential for enzymatic activity of group B streptococcal hyaluronate lyase

Parascalene block is a technique of blocking the brachial plexus at the lateral border of the anterior scalene muscle superior to the clavicle. The objective of this study was to define the position of the needle in parascalene block with relationship to the brachial plexus and the dome of the pleura, which is important in determining whether this technique minimizes the incidence of pneumothorax. In the first group, 10 patients scheduled for minor upper extremity surgery agreed to parascalene block, which was performed in the computed tomographic examination room. In the second group, 10 volunteers agreed to have markers placed at the point where a needle would be inserted for parascalene block. The computed tomographic study at the level of the needle insertion or the marker revealed that this level was superior to the dome of the pleura. The distances from the skin to the interscalene groove and the interscalene groove to the first rib at the level of the needle insertion or the marker in both groups were measured to be 17 +/- 4 mm and 15 +/- 3 mm, respectively. This study suggests that the level of the parascalene needle entry is superior to the dome of the pleura. At this level, the incidence of pneumothorax should be minimized.     

Comparison of conventional anterior surgery and laparoscopic surgery for inguinal-hernia repair

BACKGROUND: Inguinal hernias can be repaired by laparoscopic techniques, which have had better results than open surgery in several small studies. METHODS: We performed a randomized, multicenter trial in which 487 patients with inguinal hernias were treated by extraperitoneal laparoscopic repair and 507 patients were treated by conventional anterior repair. We recorded information about postoperative recovery and complications and examined the patients for recurrences one and six weeks, six months, and one and two years after surgery. RESULTS: Six patients in the open-surgery group but none in the laparoscopic-surgery group had wound abscesses (P=0.03), and the patients in the laparoscopic-surgery group had a more rapid recovery (median time to the resumption of normal daily activity, 6 vs. 10 days; time to the return to work, 14 vs. 21 days; and time to the resumption of athletic activities, 24 vs. 36 days; P<0.001 for all comparisons). With a median follow-up of 607 days, 31 patients (6 percent) in the open-surgery group had recurrences, as compared with 17 patients (3 percent) in the laparoscopic-surgery group (P=0.05). All but three of the recurrences in the latter group were within one year after surgery and were caused by surgeon-related errors. In the open-surgery group, 15 patients had recurrences during the first year, and 16 during the second year. Follow-up was complete for 97 percent of the patients. CONCLUSIONS: Patients with inguinal hernias who undergo laparoscopic repair recover more rapidly and have fewer recurrences than those who undergo open surgical repair.     

Radiographic damage in large joints in early rheumatoid arthritis: relationship with radiographic damage in hands and feet, disease activity, and physical disability

An assessment of the onset of radiographic damage in the large joints (hip, knees, shoulders, elbows, ankles and tarsus) in patients with early rheumatoid arthritis, and the relationship of the progression of large joint damage with joint damage in hands and feet, with physical disability, and with cumulative disease activity, was performed in a prospective 6 yr follow-up study. Large joint damage appeared to be an early phenomenon with 20% of the patients having some damage in at least one large joint within 1 yr, and 50% of the patients within 6 yr after disease onset. Radiographic damage in large joints was significantly related to the damage in hands and feet, the physical disability index, and the cumulative disease activity. The initial disease activity at study entry was the only prognostic factor that reached significance.