Hepatic adenosine triphosphate-dependent Ca2+ transport is mediated by distinct carriers on rat basolateral and canalicular membranes.

To characterize and localize hepatic plasma membrane ATP-dependent Ca2+ transport and Na+/Ca2+ exchange, studies were performed using highly purified rat basolateral and canalicular membrane vesicles. ATP-dependent Ca2+ transport activity was present in vesicles from both domains, insensitive to azide, oligomycin, oxalate, calmodulin, and calmidazolium, and virtually abolished at pH 6.8. However, basolateral and canalicular transport differed significantly. While basolateral transport was markedly stimulated by 1 mM Mg2+, canalicular transport was Mg2+ independent. Basolateral transport was similar at pH 7.4 and 8.0 but canalicular activity was stimulated fourfold at pH 8.0. Both Ca2+ Km [1.4 +/- 0.1 (SE).10(-8) vs. 4.8 +/- 0.7.10(-8) M] and Vmax (3.6 +/- 0.1 vs. 9.0 +/- 0.6 nmol mg-1 protein min-1) were lower in basolateral than in canalicular vesicles. Basolateral transport was somewhat more nucleotide specific (for ATP) and sensitive to vanadate (IC50 130 vs. 500 microM, respectively) than was canalicular transport. Na+/Ca2+ exchange activity was not detected in membranes from either domain. These studies suggest that hepatic ATP-dependent Ca2+ transport is mediated by domain-specific carriers on the basolateral and canalicular membranes.

Adolescent victims of sexual assault.

PURPOSE: The purpose of this study was to evaluate a group of female adolescent victims (n = 176) of sexual assault and assess the similarities and differences between them and older female victims. METHODS: All the adolescents in this study were physically mature. The demographic data and the findings of the medical evaluation are compared with those of women, 25-44 years of age, who were assaulted during the same time period (n = 197). RESULTS: The mean age of the adolescent patients was 15.2 (+/- 1.6), while the control group had a mean age of 31.9 (+/- 5.1). Racial distribution was similar in both groups. One hundred thirty-nine (79%) adolescents reported prior consensual sexual activity and 32 (18%) had been pregnant at least once. Thirty-one adolescents (19%) reported a previous sexual assault. Many adolescent victims (64%) knew their assailant. Weapons or physical force was used less frequently to subdue an adolescent victim, and firearms were used very infrequently in adolescent assault. Use of alcohol or drugs just prior to the assault was prevalent among adolescent victims (47%). Finally, adolescent victims were less likely to sustain physical injuries during the assault. CONCLUSION: The preexisting relationship between the victim and the assailant may explain other elements that distinguish an adolescent rape victim from her adult counterpart. Compared to adolescent victims, the assault on adult women is more often perpetrated by a stranger, the victim is more likely to be abducted, and weapons, especially firearms, are more likely to be used to carry out the victim's capture.

Teaching pediatric and adolescent gynecology: a pilot study at one institution.

PURPOSE: To assess resident physicians' clinical recognition skills in Pediatric and Adolescent Gynecology. MATERIALS: 1) A questionnaire to identify demographic data and self-assessment as to the ability to perform a gynecologic evaluation of children. 2) Twenty color photographs of normal genitalia and common gynecologic problems in children. PARTICIPANTS: Sixty-one University of Tennessee resident physicians; 51 from the Memphis campus--20 obstetrics-gynecology (Ob-Gyn) residents, 20 pediatrics residents, and 11 family practice residents--and 10 Ob-Gyn residents from the Chattanooga campus. MAIN OUTCOME MEASURES: Ability to identify normal features of the prepubertal genitalia and to diagnose common gynecologic disorders. RESULTS: Ob-Gyn residents from the University of Tennessee, Memphis scored significantly better (58.1% correct) than did the other three groups; 38.8, 36.9, and 39.1%, respectively (p = .009). Mean performance score increased with higher pediatric gynecology PGY levels. PGY-4s performed best, whereas PGY-1s scored the lowest, with mean scores of 57.5% and 35.3%, respectively (p = .021). Residents who reported having a well-defined program in pediatric gynecology scored significantly better than those who did not have such a program, 55.3% and 39.5%, respectively (p < .001). CONCLUSIONS: A well-defined program in pediatric gynecology enhances resident education and provides them with better tools to perform gynecologic evaluations of children and adolescents.

And now for the rest of the story.

PIP: Communication between all involved parties is important for the patient with a complicated medical history. Such interactions amongst physicians was the topic of a Loss Prevention Seminar. The patient was a 24-year-old nurse, a longterm survivor of a childhood cancer. She reported that she had suffered a serious bout of heart failure of unknown etiology. She had barely survived and was just now being allowed to return to work. She recounted that her cardiologist had halted her contraceptive to prevent development of blood clots and had instructed her that she should never become pregnant, because her hear was to weak and show would never survive the pregnancy. The cardiologist had recommended sterilization as being in her best interest. She reported a residual ejection fraction of 20% from cardiac catheterization and echocardiograms. In view of the patient's age and the potential for hemodynamic compromise during surgery, various options were discussed including the long-acting progestational agent, Norplant. This would pose no cardiac risk and would be easily reversed. She agreed to this alternative provided the plan was acceptable to the cardiologist. A series of correspondences was found between her cardiologist and the cancer clinic regarding the initial hospitalization for the heart condition. The record also contained a letter from a second cardiologist who corroborated the patient's story. Then the referring cardiologist was contacted and gave a much different assessment of the situation. The cardiologist reported that the patient had indeed suffered a severe case of viral endocarditis. He had discontinued her oral contraceptives and had told her that she should not get pregnant until after she had made a significant recovery. He had never recommended sterilization. In fact, he had seen her recently and informed her that she had made excellent recovery thus far. He agreed that Norplant was a good choice of contraception for her.^ieng