Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness.

PURPOSE: We determined the efficacy and safety of pelvic floor myofascial physical therapy compared to global therapeutic massage in women with newly symptomatic interstitial cystitis/painful bladder syndrome. MATERIALS AND METHODS: A randomized controlled trial of 10 scheduled treatments of myofascial physical therapy vs global therapeutic massage was performed at 11 clinical centers in North America. We recruited women with interstitial cystitis/painful bladder syndrome with demonstrable pelvic floor tenderness on physical examination and a limitation of no more than 3 years' symptom duration. The primary outcome was the proportion of responders defined as moderately improved or markedly improved in overall symptoms compared to baseline on a 7-point global response assessment scale. Secondary outcomes included ratings for pain, urgency and frequency, the O'Leary-Sant IC Symptom and Problem Index, and reports of adverse events. We compared response rates between treatment arms using the exact conditional version of the Mantel-Haenszel test to control for clustering by clinical center. For secondary efficacy outcomes cross-sectional descriptive statistics and changes from baseline were calculated. RESULTS: A total of 81 women randomized to the 2 treatment groups had similar symptoms at baseline. The global response assessment response rate was 26% in the global therapeutic massage group and 59% in the myofascial physical therapy group (p=0.0012). Pain, urgency and frequency ratings, and O'Leary-Sant IC Symptom and Problem Index decreased in both groups during followup, and were not significantly different between the groups. Pain was the most common adverse event, occurring at similar rates in both groups. No serious adverse events were reported. CONCLUSIONS: A significantly higher proportion of women with interstitial cystitis/painful bladder syndrome responded to treatment with myofascial physical therapy than to global therapeutic massage. Myofascial physical therapy may be a beneficial therapy in women with this syndrome.

S U ( 3 ) C × S U ( 2 ) L × U ( 1 ) Y × U ( 1 ) X as a symmetry of division algebraic ladder operators.

We demonstrate a model which captures certain attractive features of SU(5) theory, while providing a possible escape from proton decay. In this paper we show how ladder operators arise from the division algebras R , C , H , and O . From the SU(n) symmetry of these ladder operators, we then demonstrate a model which has much structural similarity to Georgi and Glashow's SU(5) grand unified theory. However, in this case, the transitions leading to proton decay are expected to be blocked, given that they coincide with presumably forbidden transformations which would incorrectly mix distinct algebraic actions. As a result, we find that we are left with G sm = S U ( 3 ) C × S U ( 2 ) L × U ( 1 ) Y / Z 6 . Finally, we point out that if U(n) ladder symmetries are used in place of SU(n), it may then be possible to find this same G sm = S U ( 3 ) C × S U ( 2 ) L × U ( 1 ) Y / Z 6 , together with an extra U ( 1 ) X symmetry, related to B - L .

Pulmonary alveolar proteinosis in two siblings with decreased immunoglobulin A.

A brother and sister with classic, biopsy proved pulmonary alveolar proteinosis are described. Both had low serum and low normal secretory immunoglobulin A (IgA) levels. A tendency for familial occurrence is possible and it is recommended that patients with pulmonary alveolar proteinosis, and their families, be evaluated for immunologic deficiencies.

Histopathologic analysis of failed vascularized fibular grafts in femoral head osteonecrosis.

Salient histopathological features in 13 failed free vascularized fibular autografts implanted for osteonecrosis of the femoral head are documented. Of particular clinical and/or biomechanical relevance are 1-2-mm-thick seams of viable lamellar bone bonded circumferentially to anatomically intact but necrotic graft cortices, which appear to preclude their revascularization and remodeling. Surrounding the grafts are 3-6-mm-thick rings of reactive bone, fused in many sites (average approximately 54%) to the osseous seams. They consist of a layer of sclerotic cortical-like bone melded with an outer layer of thickened cancellous bone. This remodeled reactive bone, largely the result of drilling, appears to buttress the grafts structurally and by inference, functionally. Operative failures in all but one case are attributed primarily to collapse of the necrotic, fractured superior subtending segment of the graft and of the subchondral plate secondary to size and progression of the osteonecrosis and superimposed osteoarthrosis. Morphological integrity of grafts elsewhere and perifibular reactive sclerotic bone remain unimpaired for up to 5 1/2 years. The salutary features of vascularized autografts would appear to give them a decided advantage over their nonvascularized counterpart.

Granulomatous prostatitis: a hypoechoic lesion of the prostate.

Numerous benign and malignant entities can disrupt the normal prostatic parenchymal architecture producing hypoechoic lesions in the peripheral zone. We report two cases of granulomatous prostatitis mimicking carcinoma. The differential diagnosis of hypoechoic lesions and the etiologies of granulomatous prostatitis are discussed. All hypoechoic lesions in the peripheral zones of the prostate require biopsy for histologic diagnosis.

Weight gain during adolescent pregnancy. Associated maternal characteristics and effects on birth weight.

Prospective data from 696 adolescents who delivered at 37 weeks or more gestation were analyzed to determine factors associated with weight gain during pregnancy and effects of pregnancy gains on birth weight and other outcomes of pregnancy. Pregnancy weight gain was found to be associated with the following factors: mother's ethnicity, length of gestation, parity, and presence of pregnancy-related hypertension. Maternal weight gain during pregnancy markedly increased infant birth weight. The risk of a low birth-rate infant was greatly reduced (OR = 0.14; CL = 0.1-0.2), and the risk of a macrosomic infant was 13.1 times higher (OR = 13.1; CL = 8.9-19.2) in adolescents gaining 20 kg or more. There was no increased risk for Caesarean section, fetal/neonatal death, or neonatal intensive care unit admission based on maternal weight gain. No effect of prepregnant relative weight on maternal weight gain was detected. The effect of weight gain on birth weight was also independent of the maternal prepregnant relative weight.