The Association of Health Locus of Control with Clinical and Psychosocial Aspects of Living with Multiple Sclerosis.

Health Locus of control (LOC) refers to one's beliefs regarding control over one's health. This study aimed to determine the relationship between LOC on clinical and psychosocial aspects associated with multiple sclerosis (MS). 5059 participants with MS completed a questionnaire pack including the Multidimensional Health Locus of Control Scale. Associations between LOC and sociodemographic (age, gender, educational level) and clinical variables (duration, disability, depression, anxiety, self-efficacy, QoL) were explored. LOC was found to be significantly associated with all of the clinical variables and age, but not gender or educational level. When controlling for level of disability, Chance (CLOC) was associated with higher self-efficacy, lower anxiety and higher QoL than Powerful Others (PLOC), while Internal (ILOC) had no association. The proportion with ILOC preference was lower in increased disability. In MS, believing that health is controlled mainly by chance confers the most benefit with regard to quality of life. There is prima-facie evidence that LOC preference changes with MS progression, in a pattern that is protective against psychological distress.

Erythrocyte receptors for (Plasmodium knowlesi) malaria: Duffy blood group determinants.

Duffy blood group negative human erythrocytes (FyFy) are resistant to infection by Plasmodium knowlesi, a simian malaria that infects Duffy positive human erythrocytes. The P. knowlesi resistance factor, Duffy negative erythrocytes, occurs in high frequency in West Africa, where the people are resistant to vivax malaria. This suggests that Duffy blood group determinants (Fya or Fyb) may be erythrocyte receptors for P. vivax.

Nucleoside deaminase: an enzymatic marker for stress erythropoiesis in the mouse.

The level of nucleoside deaminase was determined in extracts of mouse tissues obtained during a period of accelerated erythropoiesis induced by hypoxia, hemorrhage, or the injection of phenylhydrazine. Under these conditions a striking (10- to 100-fold) elevation of the enzyme activity occurred in the spleen. Similar results were obtained with the injection of purified erythropoietin. In control animals, only a trace of nucleoside deaminase activity was detected in the blood. During the reticulocyte response which followed erythropoietic stimulation, there was a sharp increase in the blood level of nucleoside deaminase, which rose up to 120 times that of control animals. By differential centrifugation, the enzyme was localized to the reticulocyte-rich fraction. Erythrocyte nucleoside deaminase remained elevated even after the reticulocyte count had fallen to normal in the phenylhydrazine-treated mice or to zero after the cessation of hypoxia. There was a very gradual decline in the enzyme activity in the blood which fell to the barely detectable control levels about 45 days after the initial reticulocyte response, a time period which corresponds to the survival of the mouse red blood cell. The persistence of high levels of nucleoside deaminase for the full life span of a generation of erythrocytes formed during stress, viewed in contrast to the virtual absence of the enzyme from normal erythrocytes of all ages, represents an enzymatic difference between the normal red blood cell and the cell produced under conditions of accelerated erythropoiesis.

Procainamide-induced agranulocytosis and thrombocytopenia.

Procainamide therapy has frequently been reported as a cause of agranulocytosis, but severe thrombocytopenia associated with the use of this drug has been noted only once. We report a case of simultaneously occurring agranulocytosis and profound thrombocytopenia in a patient receiving procainamide hydrochloride. Different mechanisms appeared to be responsible for the two cytopenias.

Prostatodynia and interstitial cystitis: one and the same?

OBJECTIVES: To investigate further the observation that men with prostatodynia may represent a subset of patients with interstitial cystitis. METHODS: The charts of 20 patients with the diagnosis of nonbacterial prostatitis or prostatodynia who underwent cystoscopy and bladder hydrodistention were retrospectively reviewed. RESULTS: The primary complaint of all 20 patients was genital or rectal pain, or both. Ten patients reported irritative voiding symptoms. Twelve of the 20 patients developed petechial hemorrhages involving the bladder uroepithelium on hydrodistention. Bladder biopsies revealed no significant histopathologic abnormalities. Nine of the 12 patients who developed petechial hemorrhages reported symptomatic improvement at 2- to 3-week follow-ups compared with none of the 8 patients without petechial hemorrhages. CONCLUSIONS: These findings suggest that the diagnosis of interstitial cystitis should be considered in patients with nonbacterial prostatitis or prostatodynia.

Seminal fluid findings in men with nonbacterial prostatitis and prostatodynia.

There is considerable confusion about the effects of prostatitis syndromes on male reproductive physiology. Therefore, we correlated findings on seminal fluid and expressed prostatic secretions from 100 men attending a special prostatitis clinic. These men had symptoms of prostatitis but no evidence of urethritis, acute or chronic bacterial prostatitis, or significant urological abnormalities. All subjects were evaluated following a standardized protocol, including lower urinary tract localization studies, expressed prostatic secretion analyses, and seminal fluid analyses with Bryan-Leishman staining. Seminal fluid findings were compared in men with inflammation (> or = 10(6) leukocytes/ml) in their expressed prostatic secretions, i.e., nonbacterial prostatitis, and men without inflammation in prostatic secretions, i.e., prostatodynia. Of 23 men with inflammation (> or = 10(6) leukocytes/ml) in their seminal fluid, 6 (26%) had nonbacterial prostatitis (mean leukocyte concentration 8.6 +/- 9.4 x 10(6)/ml of semen) and 17 (74%) had prostatodynia (mean leukocyte concentration 6.2 +/- 7.0 x 10(6)/ml, not significant). Of 77 men who did not have seminal inflammation, 15 (19%) had nonbacterial prostatitis (mean leukocyte concentration 0.1 +/- 0.2 x 10(6)/ml) and 62 (81%) had prostatodynia (mean leukocyte concentration 0.1 +/- 0.2 x 10(6)/ml, not significant). Men with nonbacterial prostatitis had lower values for several parameters associated with sperm motility, especially the proportion of motile sperm (45% compared with 60% for men with prostatodynia, P = 0.08) and sperm subjective speed score (median 3 compared to 4 for men with prostatodynia, P = 0.03). In summary, a minority of men had seminal inflammation, even among men with nonbacterial prostatitis. There was poor correlation between inflammation in the prostatic secretions and in the semen. Nonbacterial prostatitis, but not seminal inflammation, was associated with reduced sperm motility. Our findings highlight technical issues and the importance of investigating different sites and samples, including the urethra, expressed prostatic secretions, and seminal fluid.

Psychological and physical factors involved in chronic idiopathic prostatitis.

Idiopathic prostatitis is a common, often chronic condition in which psychological factors are suspected to play a role. Men with chronic prostatitis (n = 51) and a control group of 34 men without any chronic pain condition, equivalent on demographic characteristics, were compared on psychological and perineal muscle tension measures. Prostate-specific antigen and expressed prostatic secretion cell counts were also measured. Chronic prostatitis patients were consistently more elevated than controls on hypochondriasis, depression, and hysteria (MMPI), and on somaticization and depression (Brief Symptom Inventory), and were less elevated on masculine/instrumentality (Personal Attributes Questionnaire) scales. A cluster analysis of MMPI profiles revealed that 57% of the chronic prostatitis patients produced generally unelevated MMPI profiles, whereas the remaining 43% fell into two groups with distinct patterns of distress. The results indicate depression and psychosocial distress are common among chronic prostatitis patients, calling for careful evaluation and attention to psychological symptoms.

Relation between the race and economic status of patients and who performs their surgery.

We evaluated the relation between race and economic status of surgical patients and their likelihood of being treated by a surgeon in training rather than by a staff surgeon. Blacks were 2.2 to 4.3 times more likely than whites to be under the care of surgeons in training (P less than 0.001). This relation has remained unchanged over the past two decades. It remained when the method of payment was via self-payment or private insurance, but disappeared when patients being paid for by Medicaid were considered. In addition, black emergency patients were more likely than white emergency patients to be cared for by surgeons in training.

Porokeratosis of Mibelli following heart transplant.

A 59-year-old white man with a history of Sydenham's chorea received a mitral valve prosthesis in 1962. He sustained an anterolateral myocardial infarction in 1983. In 1984, he received a heart transplant. To prevent heart rejection, he was initially treated with cyclosporine 12 mg/kg/day and prednisone 90 mg b.i.d. In 1987, azathioprine 100 mg daily was added. In 1989, at the time of our evaluation, his medications included cyclosporine 80 mg b.i.d., prednisone 10 mg b.i.d., and azathioprine 75 mg/day. Since his heart transplant surgery he had not taken any thiazide medication. The patient noted a lesion on his right thigh; the lesion appeared in 1986, 2 years after his heart transplant. On examination in 1989, the lesion was a 2 cm wide annular plaque with a shiny atrophic center and raised border. Both the clinical appearance and pathology were consistent with a diagnosis of porokeratosis of Mibelli. No family history of porokeratosis was elicited.

Is ouabain produced by the adrenal gland?

1. Ouabain or a related stereoisomer, termed endogenous ouabain, has been identified in adrenal cortex tissue and culture medium from adrenocortical cells. 2. Angiotensin II and adrenocorticotropin, the main activators of aldosterone secretion from adrenal glomerulosa cells appear to increase the production of this compound. 3. The purpose of this review is to briefly discuss recent available experimental evidence suggesting that endogenous ouabain is secreted by the zona glomerulosa of the adrenal gland.

Congenital malformations in newborns of women with established and gestational diabetes in Washington State, 1984-91.

We examined the relationship between diabetes in pregnancy and the development of congenital malformations, in a population-based retrospective study using birth certificate data for all liveborn children delivered from 1984 until 1991 in Washington State. Births to mothers with established and gestational diabetes numbered 1511 and 8869 respectively. For comparison we selected 8934 births to mothers without diabetes. The prevalence of congenital malformations in neonates was 7.2%, 2.8% and 2.1% among mothers with established diabetes, gestational diabetes, and without diabetes, respectively. Newborns of mothers with established diabetes were more likely to have a congenital malformation than newborns of non-diabetic mothers (prevalence odds ratio = 4.0; 95% confidence interval 3.1-5.1). In contrast, there was only a slightly higher prevalence of congenital malformations among newborns of mothers with gestational diabetes (prevalence odds ratio = 1.3; 95% CI 1.0-1.6). The association with maternal established diabetes was greater for neonates with multiple malformations (7.8; 95% CI 3.3-18.1) than for single malformations (2.9-95% CI 2.1-3.9). Four to seven fold associations were observed with skeletal, cleft lip/palate, neural tube and heart abnormalities. The association of established diabetes with congenital malformations was nearly twice as strong among female neonates (prevalence odds ratio = 5.4; 95% CI 3.7-8.0) than among male neonates (prevalence odds ratio = 3.1; 95% CI 2.2-4.5). No such variation was observed for associations with gestational diabetes. This study enlarges on previous work relating congenital anomalies to established diabetes and supports the possibility of a weak association with gestational diabetes.