History and current status of infant formulas.

Formulas that approximate the composition of human milk are widely used as the sole source of nutrients for infants during the first months of life. Such formulas contain milk, soy, or meal proteins, or protein hydrolysates together with those forms of fat carbohydrate, vitamins, and minerals shown to be bioavailable to the infant. Legislation concerning nutrient composition and quality assurance of products labeled as infant formulas has been enacted by Congress. Governmental and industrial standards also help to assure microbiological safety and stability. Problems of nutrient composition and adverse reactions have occurred during the evolution and development of infant formulas. Problems concerning nutrient deficiency are now almost unknown, but adverse reactions of individuals to specific formula ingredients continue. Accurate information on composition and related nutritional properties of infant formulas is essential for their effective use and for the avoidance of undesirable complications.

The clinical biomechanics award paper 1993 Posture and the compressive strength of the lumbar spine.

The effect of posture on spinal compressive strength was examined in a series of three experiments on cadaveric material. Lumbar 'motion segments', consisting of two vertebrae and the intervening disc and ligaments, were compressed while positioned in various angles of flexion and extension. In the first experiment load sharing between the disc, the apophyseal joint surfaces, and the intervertebral ligaments was inferred from measurements of intradiscal pressure (IDP). Results showed that extension caused the apophyseal joints to become load-bearing, and damage could occur at compressive loads as low as 500 N. Flexion angles greater than about 75% of the full range of flexion (as defined by the posterior ligaments) generated high tensile forces in these ligaments, and caused substantial increases in IDP. The optimum range for resisting compression therefore appeared to be 0-75% flexion. The second experiment compared the distribution of compressive stress within the disc at the endpoints of this range, and showed that at 0% flexion high stress concentrations occur in the posterior annulus of many discs, whereas an even distribution of stress was usually found at 75% flexion. However, the third experiment showed that there was no significant difference in the compressive strength of motion segments positioned in 0% and 75% flexion. A comparison of the range of flexion/ extension movements in vivo and in vitro led us to conclude that in life a position of moderate flexion is to be preferred when the lumbar spine is subjected to high compressive forces.

Oral histoplasmosis in HIV-infected patients. A report of two cases.

Histoplasmosis is a fungal infection caused by the organism Histoplasma capsulatum. Disseminated disease usually occurs in immunosuppressed patients or in patients with chronic illnesses. Although relatively uncommon, histoplasmosis has been reported in patients with AIDS, and oral lesions have been noted on multiple sites and in various clinical presentations. We present two HIV-positive cases with oral lesions as the initial signs of histoplasmosis. Both patients responded well to IV amphotericin B but later suffered recurrences despite being maintained on systemic antifungal therapy.

25 years of kidney transplantation in Hawaii.

The first kidney transplant in Hawaii was performed in August 1969. In the following 25 years, more than 433 kidney transplants were performed. The most common etiology leading to transplantation was chronic glomerulonephritis. Patient and graft survivals after a kidney transplant have progressively improved, particularly after the introduction of cyclosporine in 1984. The overall one-year patient and graft survival rates now are 96% and 85%, respectively; these results exceed the national averages.

Clinical characteristics and management outcome in the burning mouth syndrome. An open study of 130 patients.

Clinical characteristics and treatment responses were studied in 130 patients with burning mouth syndrome (BMS). Most patients were postmenopausal women, and the tongue was the most frequently afflicted site. Although 39% of the patients complained of dry mouth, no causative factors were evident. Therefore BMS is assumed to be a functional disorder. This was at least partially confirmed because the most effective management was in response to mood-altering drugs. From our data BMS appears to be a chronic condition with variations in symptoms among patients and without a predictable endpoint.

Blunt urinary tract trauma: identifying those patients who require radiological diagnostic studies.

We evaluated prospectively 506 consecutive patients who presented with a history of blunt trauma and hematuria. All patients initially underwent excretory urography and cystography. Of the 506 patients 25 had detectable urinary tract injuries that were confirmed either by the initial studies or by computerized tomography, angiography or direct intraoperative inspection. Diagnoses included 7 renal contusions, 7 renal lacerations (1 major and 6 minor), 1 renal artery, 3 intraperitoneal and 5 extraperitoneal bladder ruptures, and 2 urethral injuries. Of the 25 patients 21 presented with gross hematuria, including all of those with lower tract injuries. One of the 4 patients who presented with microhematuria was hospitalized in shock. Of the remaining 3 patients with microhematuria and no shock 1 had a minor renal laceration and 2 had renal contusions. All 3 patients were managed conservatively and all 3 were hospitalized chiefly for associated nonurological injuries. If the patients who presented with microhematuria and no shock were excluded from initial radiographic evaluation, 1 minor renal laceration and 2 renal contusions would have been missed. If we had added 1 more exclusion criterion, that of absence of major associated injuries, we would not have missed an injury.

The role of transabdominal ultrasound in the preoperative evaluation of patients with benign prostatic hypertrophy.

We evaluated 59 consecutive patients for obstructive voiding symptoms with physical examination, excretory urography, urethrocystoscopy, post-voiding residual volumes, uroflowmetry and transabdominal ultrasound of the prostate. Of the patients 53 underwent transurethral resection of the prostate and 6 underwent open prostatectomy. Followup uroflowmetry was done 4 weeks postoperatively. The best predictor of the actual prostatic weight was transabdominal ultrasound (r equals 0.975), and with digital rectal examination and urethrocystoscopy there was a tendency to overestimate small and underestimate large glands. Symptoms such as nocturia do not allow any conclusions about the size of the prostate. The correlation between post-void residual and specimen weight also is poor and only patients in retention (Foley catheter) have a significantly larger prostate. Preoperative uroflowmetry provides limited information about the prostatic size but, although the difference between the preoperative and postoperative flow rate index is highly significant (p less than 0.001, mean difference test), the correlation between specimen weight, and the difference between preoperative and postoperative flow rate index is not significant. We recommend transabdominal sonography of the prostate, a simple and noninvasive procedure, as a useful adjunct in the preoperative evaluation of patients with benign prostatic hypertrophy. In addition to the fact that only this method provides reliable and reproducible estimations of the weight of the prostate, further information, such as measurement of the post-void residual volume, can be obtained without additional costs or loss of time.

Synthesis and identification of a third component of the San Jose scale sex pheromone.

Two components of the San Jose scale sex pheromone had previously been identified as 7-methyl-3-methylene-7-octen-1-yl propanoate (I) and (Z)-3,7-dimethyl-2,7-octadien-1-yl propanoate (II). An isomer and various homologs have subsequently been synthesized and tested in a greenhouse bioassay. TheE isomer of II (XI) was found to be attractive to male scales. This compound has now been isolated and identified from airborne extracts of virgin female scales. The composition of the natural pheromone was 48.5%, 46.7%, and 4.8% of I, II, and XI, respectively. In field tests in California and New York, synthetic XI was found to be attractive to male scales alone and in combination with I and II, but there was no obvious increase in trap catch when the synthetic isomers were present in the same ratio as in the natural blend.

Oral Kaposi's sarcoma: a 10-year retrospective histopathologic study.

Microscopic diagnosis of early Kaposi's sarcoma continues to be a challenge to the pathologist, as does the identification of bacillary angiomatosis (BA) which may have a similar appearance. 120 oral Kaposi's sarcoma (KS) biopsies submitted to the UCSF oral pathology service from 1981-1991 were reviewed in order to describe the clinical-pathologic spectrum of these lesions and to search for unrecognized cases of BA. Also, histopathologic features of oral KS were compared to 30 oral pyogenic granulomas, and immunohistochemical stains for endothelium-associated CD34 antigen were done. The diagnosis of KS was confirmed in all biopsies and no cases of BA were found. Histologically, the KS specimens exhibited numerous features that separated them from pyogenic granulomas, and could themselves be divided into two clinical-pathologic subtypes: small, well-delineated macular lesions (31), which were characterized by inconspicuous patches of spindle cells containing ill-defined vascular spaces; and larger, infiltrative nodular lesions (89), which were characterized by spindle cells lining vascular slits and bizarre-shaped vessels. Extravasated RBCs were evident in almost all KS lesions; hemosiderin deposits and hyaline globules were seen in half of each of the small and large lesions. Nuclear atypia was minimal and mitotic activity was slight. Lymphocytes in small lesions added to the difficulty of microscopic interpretation of these incipient lesions. CD34 was expressed on all spindle cells lining vascular spaces in larger lesions and on spindle cells of small, subtle lesions. We conclude that within the spectrum of lesions that are diagnosed as oral KS, two clinical-pathologic types can be identified: macular small spindle-cell lesions and nodular infiltrative vascular lesions.(ABSTRACT TRUNCATED AT 250 WORDS)