Suspended particulate matter: concentration in the major oceans.

Quantitative data from over 500 concentrates of suspended particulate material has been summarized statistically for the Atlantic, Pacific, and Indian oceans, the Gulf of Mexico, and the Caribbean Sea. From clear ocean water a majority of samples were in the range of 0 to 9.9 milligrams per 200 liters and the next largest number were in the range of 10 to 19.9 milligrams per 200 liters. Certain areas of cloudy or nepheloid water, observed photographically, contain relatively more samples in heavier concentration ranges and have larger mean values than clear ocean water.

Mineral source and transport in waters of the gulf of Mexico and Caribbean sea.

Mineral particles suspended in the Gulf of Mexico and Caribbean Sea were analyzed in relation to clay mineral distributions in bottom sediments, to sedimentation processes active in the region, and to the prevailing currents. Circulation in the upper layers of water flowing from the Caribbean, carrying a micaceous-rich mineral assemblage, has exercised an influence on mineral transport into the Gulf of Mexico, different from the montmorillonite-rich load delivered by the Mississippi River. Particulate matter, suspended in North Atlantic water and Amazon River discharge, enters the Caribbean through the Lesser Antilles and contributes to the detrital mineral content of Caribbean water, as does that carried by the wind.

Cerebral Perfusion Is Perturbed by Preterm Birth and Brain Injury.

BACKGROUND AND PURPOSE: Early disturbances in systemic and cerebral hemodynamics are thought to mediate prematurity-related brain injury. However, the extent to which CBF is perturbed by preterm birth is unknown. Our aim was to compare global and regional CBF in preterm infants with and without brain injury on conventional MR imaging using arterial spin-labeling during the third trimester of ex utero life and to examine the relationship between clinical risk factors and CBF. MATERIALS AND METHODS: We prospectively enrolled preterm infants younger than 32 weeks' gestational age and <1500 g and performed arterial spin-labeling MR imaging studies. Global and regional CBF in the cerebral cortex, thalami, pons, and cerebellum was quantified. Preterm infants were stratified into those with and without structural brain injury. We further categorized preterm infants by brain injury severity: moderate-severe and mild. RESULTS: We studied 78 preterm infants: 31 without brain injury and 47 with brain injury (29 with mild and 18 with moderate-severe injury). Global CBF showed a borderline significant increase with increasing gestational age at birth (P = .05) and trended lower in preterm infants with brain injury (P = .07). Similarly, regional CBF was significantly lower in the right thalamus and midpons (P < .05) and trended lower in the midtemporal, left thalamus, and anterior vermis regions (P < .1) in preterm infants with brain injury. Regional CBF in preterm infants with moderate-severe brain injury trended lower in the midpons, right cerebellar hemisphere, and dentate nuclei compared with mild brain injury (P < .1). In addition, a significant, lower regional CBF was associated with ventilation, sepsis, and cesarean delivery (P < .05). CONCLUSIONS: We report early disturbances in global and regional CBF in preterm infants following brain injury. Regional cerebral perfusion alterations were evident in the thalamus and pons, suggesting regional vulnerability of the developing cerebro-cerebellar circuitry.

Childhood adiposity and fertility difficulties: the Bogalusa Heart Study.

BACKGROUND: Adult obesity is associated with infertility; however, childhood obesity has received little consideration. OBJECTIVES: The present study sought to evaluate the impact of childhood adiposity on fertility. METHODS: Associations between childhood adiposity and self-reported fertility difficulties were estimated among women participating in a long-term study of cardiovascular risks and reproductive health (n = 1061). RESULTS: Participants with obesity between ages 9 and 12 were more likely to report fertility difficulties (adjusted relative risk [aRR], 1.82, 95% CI 1.17-2.82) and inability to become pregnant when trying (aRR = 1.94, 95% CI 1.22-3.08) as were those with obesity prior to age 9 (aRR = 1.76, 95% CI 1.04-2.97). Similar associations were seen among those ever overweight or obese in childhood. High subscapular skinfold thickness (age < 12) increased risk of receiving help becoming pregnant (aRR = 2.16, 95% CI 1.15-4.06), inability to become pregnant (aRR = 1.46, 95% CI 1.05-2.04) and any fertility difficulties (aRR = 1.56, 95% CI 1.13-2.14); associations for triceps skinfold were attenuated. Participants with increased adiposity also had fewer pregnancies and live births. Effects persisted, excluding women with polycystic ovarian syndrome. CONCLUSIONS: This study supports an association between childhood adiposity and infertility, not solely driven by polycystic ovarian syndrome.

Maternal apolipoprotein E genotype as a potential risk factor for poor birth outcomes: The Bogalusa Heart Study.

OBJECTIVE: The objective of this study was to assess the association between apolipoprotein E (apoE) genotype and preterm birth (PTB) and small for gestational age (SGA). STUDY DESIGN: ApoE phenotyping was performed on 680 women linked to 1065 births. Allele frequencies were compared and PTB and SGA risk was estimated using log-binomial regression. RESULTS: The ɛ2 allele was more common in SGA births (P<0.01). SGA risk was increased among ɛ2 carriers compared with genotype ɛ3/ɛ3, though associations were attenuated following adjustment for maternal age, education, race, smoking and prenatal visits. Stronger associations were observed for term SGA (first birth: adjusted relative risk (aRR)=1.78, 95% confidence interval (CI) 1.06 to 2.98; any birth: aRR=1.52, 95% CI 0.96 to 2.40) and among whites specifically (first: aRR=2.88, 95% CI 1.45 to 5.69; any: aRR=2.75, 95% CI 1.46 to 5.22). CONCLUSIONS: Associations between maternal apoE genotype and SGA may represent decreased fetal growth in women with lower circulating cholesterol levels.

Eosinophilic fasciitis, reactive hepatitis, and splenomegaly.

Eosinophilic fasciitis (EF) is an acute, idiopathic inflammatory disorder often manifested by tender swelling of the extremities after extreme physical exertion. It is usually without visceral complications. I treated a 25-year-old man with EF who had reactive hepatitis and splenomegaly. To my knowledge, the former has never been reported and the latter only once.

Hepatic infarction related to oral contraceptive use.

The first case of oral contraceptive (OC)-related common hepatic artery thrombosis with subsequent hepatic infarction is reported. Hepatic complications of OC use are enumerated and the clinical manifestation of hepatic infarction is described. Propranolol hydrochloride, because of its effect on liver blood flow, may have contributed to this disease process.

Thrombotic and infectious complications of Hickman-Broviac catheters.

Hickman-Broviac catheters are often used when long-term venous access is required. Although generally safe, catheter-related thrombosis and infection are two of the most frequent and clinically important complications associated with their use. A 47-year-old woman with breast cancer had a Hickman catheter placed for chemotherapy; subsequently, the superior vena caval syndrome developed due to a large thrombus surrounding the catheter tip. A very low dose of streptokinase successfully lysed this clot within 12 hours. A 60-year-old woman with acute myelogenous leukemia had a Hickman catheter placed to facilitate induction and maintenance chemotherapy. Two episodes of catheter-related Staphylococcus epidermidis sepsis later developed, the first of which cleared without removal of the cannula.

Antagonist EMG temporal patterns during rapid voluntary movement.

This study of 10 normal college-aged women was designed to clarify possible antagonist control mechanisms during the silent period of the agonist in rapid elbow extension tasks. Antagonist electromyographic temporal patterns were observed after agonist silence under various conditions to determine if antagonist activity in the rapid movement was controlled supraspinally (preprogrammed), spinally (reflexively), or by a combination of the two mechanisms. The subjects followed a velocity-controlled dot displayed on an oscilloscope. The antagonist latencies remained constant during intentionally and unintentionally terminated movements, but were altered by load conditions. This was seen as an automatic deceleration response, elucidating differences between antagonist control during ballistic and rapid movements.

Quartz crystal microbalance detection of Vibrio cholerae O139 serotype.

A piezoelectric (PZ) quartz crystal microbalance (QCM) biosensor for the rapid detection of Vibrio cholerae serotype O139 has been developed. The antibody to this serotype was immobilized on the gold transducer surface of a 10 MHz AT cut PZ crystal. Solutions containing known antigen concentrations were then incubated for 1 h on the antibody-bound transducer. The biosensor was able to detect 10(5) cells per ml of O139 versus a background of O1 (Ogawa) serotype.

Enhancing the training of internal medicine residents at Stanford by establishing a model group practice and raising its clinical educators' status.

The education of residents is shifting to the ambulatory care setting. In addition, there is a growing trend toward managed care and increasing competition for patients to be served by "real-world" practices. The authors describe the formation and operation of a program that was established in 1981 at the Stanford University School of Medicine to respond to these changes: the Stanford Medical Group (SMG), a model group practice in internal medicine that operates within the academic medical center. Because raising the status of the clinician-educator faculty was a critical issue for the SMG, the authors also describe the Medical Center Professoriate, a separate faculty track created in 1989 to recognize and reward Stanford's clinician-educators. The authors conclude that the SMG has succeeded in its training and patient care goals and has weathered the great changes in the health care environment that have taken place since 1981. They also report that the separate faculty track is serving its purpose well. They hope that educators and program directors at other academic medical centers may find the descriptions of the SMG and the professoriate useful in solving similar problems.

Integration of women's health into an internal medicine core curriculum for medical students.

The authors describe their year-long collaboration to analyze and integrate the elements of women's health into their medical school's core curriculum in internal medicine for the third-year clerkship. Such a process was necessary because the current curriculum was inadequate in its treatment of women's health (e.g., little or no coverage of issues pertaining to women in teaching about certain disorders; lack of female subjects in many research studies; study designs' using standards derived from manifestations of diseases in men; the cross-discipline aspects of women's health). The authors illustrate the new curriculum by discussing the revised module in pulmonary medicine; they detail the steps they took to uncover problems and omissions in the existing curriculum and in the literature on the topic, and how they remedied these. (For example, in a case involving a man with pulmonary embolus, one of the new questions for students is "What questions would you ask if this patient were a woman?") They comment on the challenges they faced in revising the curriculum, including lack of protected time, lack of sufficient data about women's health, inherent sex and gender bias in the literature and educational materials, need to make students aware of the importance of sex and gender considerations in patient care, and the ingrained bias of faculty, including the authors. Their process can be adapted and used to integrate curricula in other emerging interdisciplinary fields, such as cross-cultural medicine and gay and lesbian health. The authors conclude that collaboration between students and faculty, as illustrated in their own efforts, is one way to ensure that future practitioners are optimally trained to treat patients in the ever-changing field of medicine.

Weaving women's health across clinical clerkships.

Clerkship directors have an opportunity to develop consensus on learning objectives for women's health issues and to develop curricula that cross disciplinary boundaries. A collaborative interdisciplinary approach assures proper sequencing of knowledge and skill acquisition, conserves educational resources, and reflects the values of connectedness and patient-centeredness that are central to women's health. The informal networks and the institutional structures that bring clerkship directors together for discussion of a variety of educational issues promote such collaboration. The authors describe three approaches to designing and implementing women's health curricula and discuss how each might be applied to the topic of domestic violence: adding free-standing courses to existing curricula, often as electives; delegating pieces of the women's health curriculum to existing courses; and creating new interdisciplinary curricula that then are integrated into the general curriculum. Each has advantages and disadvantages. Ideally, models for curriculum design will reflect the collaborative patient-centered models upon which the field of women's health is based. Such models enhance program effectiveness by taking advantage of discipline-based expertise while allowing for the sharing of both educational responsibilities and educational resources.

Iatrogenic disease and the primary care physician.

Primary care physicians need to be aware of iatrogenic disease and its causes. Adverse drug reactions, including drug-drug interactions, and certain diagnostic procedures may lead to iatrogenic complications. Hospitalized patients, especially the elderly, face increased risks of such complications. Physicians who are aware of common adverse reactions to drugs, drug combinations, and medical procedures may be able to help patients avoid unnecessary distress and morbidity.

Local subcutaneous atrophy after corticosteroid injection.

Subcutaneous atrophy developed in a 36-year-old woman at the site of a triamcinolone acetonide (Kenalog) injection for subdeltoid bursitis. Occurrence of local atrophy after corticosteroid injection is relatively frequent yet unappreciated. It is more common in young women and girls who are given preparations with a lesser degree of water solubility. Although the condition is often reversible, instances of long-term disfigurement are well documented. This complication of a useful treatment method can be avoided by following a set of precautions for local injection of corticosteroids.

Gynecomastia. A bothersome but readily treatable problem.

Although breast enlargement in boys and men can cause both psychological and physical distress, the disorder is rarely serious and is readily treatable. Several factors can lead to the estrogenic excess that causes growth of breast tissue. Dr Jacobs describes a patient with gynecomastia related to cirrhosis of the liver who responded promptly to a brief course of tamoxifen citrate therapy.

Treating the progressive stages of Parkinson's disease.

Parkinson's disease affects thousands of Americans, men and women equally and apparently with little regard to race. Its diagnosis depends largely on repeated clinical observations of representative signs, such as resting tremor, rigidity, bradykinesia, and gait disturbances. Patients progress through stages: Early disease involves only one limb or side and confers minimal disability, but advanced disease restricts patients to full care. Treatment is chosen on the basis of disease stage and patient response. Combination carbidopa-levodopa (Sinemet) is appropriate for any significant degree of disability, and other antiparkinsonian drugs and anticholinergic agents may be used as adjuncts. Electroconvulsive therapy, use of selegiline hydrochloride (Eldepryl), and surgery are still undergoing investigation but may hold promise.