Asymptomatic microscopic hematuria in women: case series and brief review.

Recommendations for the work-up of asymptomatic microscopic hematuria (AMH) often derive from studies including both men and women. This study was undertaken to determine whether that work-up is appropriate for a female patient population. We studied 49 women referred to a urogynecologist for AMH. Patients underwent formal urinalysis, urine culture and cytology, cystoscopy, and either renal ultrasound or intravenous urography (IVU). Highly significant lesions diagnosed were one renal cell carcinoma and one acute tubular necrosis (ATN). Moderately significant lesions included one candidal urinary tract infection. Insignificant lesions included bladder inflammation in 46 patients and renal cysts in 5. Our findings confirm the importance of the work-up of AMH in women. Ultrasound was effective in diagnosing upper tract lesions, with less cost and morbidity than IVU. Larger studies are needed to determine who should be screened, whether the work-up should differ for younger women, possible treatments for benign findings, and appropriate follow-up.

Regulation of ischemic cell death by glucocorticoids and adrenocorticotropic hormone.

Transient global ischemia results in delayed selective neuronal death of hippocampal CA1 pyramidal cells. Glucocorticoids increase and adrenalectomy decreases the rate of neuronal death; however, they also produce changes in brain temperature, serum glucose and adrenocorticotropic hormone levels. In order to understand the role of glucocorticoids in regulating ischemic cell death, we studied RU 38486, a glucocorticoid receptor blocker, and Org 2766, a non-steroidogenic adrenocorticotropic hormone 4-9 analog. Male Mongolian gerbils were subjected to 5 min of bilateral carotid artery occlusion under a controlled temperature environment (37.0-38.0 degrees C). Animals were injected with either physiological saline, Org 2766 (10 microg/kg/24 h) or RU 38486 (50 mg/kg/8 h), beginning just prior to the occlusion until killing at either day 4 or 7. Blood was collected for serum glucose and cortisol analysis. Damage was evaluated by blinded counts of CAI neurons. Both RU 38486 and Org 2766 treatment significantly (P<0.004) reduced hippocampal CA1 damage at day 4, but not on day 7. While RU 38486 raised serum cortisol and adrenocorticotropic hormone levels, neither treatment affected temperature or serum glucose. The fact that RU 38486 mimicked adrenalectomy without changing temperature suggests that the decreased rate of cell death resulted from either removal of glucocorticoids or increases in adrenocorticotropic hormone. The ability of Org 2766 to affect this rate strongly suggests that adrenocorticotropic hormone is the active regulatory hormone rather than glucocorticoids. While both RU 38486 and Org 2766 prolong the survival of CA1 neurons after transient global ischemia, only RU 38486, which is available and tested in both animals and humans, can block the detrimental effects of post-ischemia glucocorticoid elevations. Thus, the administration of RU 38486 may be a practical adjunct to other neuroprotective agents for victims of cardiac arrest, anesthetic accidents or drowning.

Risk factors for rapid repeat pregnancy among adolescent mothers: a review of the literature.

STUDY OBJECTIVE: To review risk factors for rapid repeat pregnancy that have been studied among adolescents, and to determine which of these factors serve as useful predictors for second pregnancy. DESIGN: A Medline search of journal articles from 1966 to 1997 identified English language articles addressing repeat pregnancy among adolescents. All relevant citations within these articles were also included. MAIN OUTCOME MEASURES: Risk factors that were correlated with rapid repeat pregnancy in studies using rigorous statistical analysis were considered to be significant. RESULTS: Significant predictors of rapid repeat pregnancy included younger age, low socioeconomic status, low education of teen's mother or head of household, marriage, intended or desired first pregnancy, and use of a contraceptive method other than Norplant postpartum. CONCLUSIONS: There is little consensus as to which risk factors are the most important predictors of recidivism. With as many as half of teenage mothers conceiving again within two years, the identification of "high-risk" teens may be less important than the development of intervention strategies for all these young women.

Asymmetrical role-taking: comparing battered and nonbattered women.

Franks's social psychological model of oppressive situations and asymmetric role-taking offers a new way of understanding the predicaments faced by battered women. Unlike individualistic or single-factor explanations, the model suggests that women faced with a particular combination of situational pressures and relationship inequities are especially vulnerable to distressful emotions and self-esteem difficulties. Survey data from 66 battered women using domestic violence services and 80 nonbattered women were collected to test the major propositions of the model. Battered women's social situations were oppressive and characterized by powerlessness, social isolation, and economic dependency. Batterers were poor empathizers. Predictions about self-blame and identification with the aggressor were not confirmed. The practical value of this theoretical approach with its emphasis on enhancing women's power base and increasing men's interpersonal sensitivity is developed.

Effect of axial load and temperature cycling on microleakage of resin restorations.

This study evaluated the microleakage of Class V resin restorations subjected to temperature and axial load cyclings. The preparations were made at the mesial and distal aspects of 29 mandibular first and second molars. The enamel margins were beveled, acid etched, washed and dried. Kerr XR Bonding System was applied to the dentin and etched enamel and Herculite composite cured in two increments. The teeth were stored in saline for 7 days, thermocycled x500 in 0.5% basic fuchsin between 8 degrees C and 50 degrees C (A); subjected to an occlusal load of 34 MPa in the dye without thermocycling (B); or followed by thermocycling (C). The leakage was scored from 0 to 4 at both the enamel and cementum aspects of the restorations. The data were analyzed by the Kruskal-Wallis test. The microstrain of five restored teeth subjected to an occlusal load of 34 MPa was measured. Microleakage of the mesial restorations was significantly greater at the cementum aspects of the restorations subjected to both temperature and occlusal loading when compared to the restorations subjected to temperature cycling or load cycling only. The microstrain in eight of the 10 restorations was significantly greater at the cementum aspects of the restorations than at the enamel aspects.

Marginal leakage and marginal gap dimensions of three dentinal bonding systems.

Standardized cylindrical Class V preparations, 3 mm in diameter and 1.5 mm deep, were made on the roots of 60 extracted human maxillary permanent canines. The teeth were restored with Scotchbond 2/Silux (S); Gluma/Lumifor (G); and Tenure/Perfection (T), respectively. The root apices were sealed with Copalite/amalgam and two coats of nail varnish applied to the teeth except for 1 mm around the restorations. For the qualitative microleakage evaluation the teeth were thermocycled x500 in 0.5% basic fuchsin between 8 degrees C and 50 degrees C and for the quantitative microleakage evaluation in 2% methylene blue solution. The marginal gap dimensions were measured on cylindrical restorations placed on the facial surfaces of ground root surfaces of 30 teeth. Epoxy replicas were made of the restorations, coated with gold/palladium and examined with the SEM. The maximum marginal gap dimensions were measured. The data were analyzed by ANOVA, Duncan's and their nonparametric analogues. In the qualitative microleakage evaluation the total microleakage was: S: 16; G: 50; T: 18. The quantitative microleakage (micrograms) was: S: 3.1 +/- 2.9; G: 16.1 +/- 5.3; T: 4.4 +/- 4.1. The maximum marginal gap dimensions (microns) were: S: 4.1 +/- 3.6; G: 9.3 +/- 3.4; T: 16.4 +/- 7.0.

Stimulation of renal and hepatic c-myc and c-Ha-ras expression by unilateral nephrectomy.

Unilateral nephrectomy induces compensatory hypertrophy of the contralateral kidney in rats, resulting in a 25% weight increase in 14 days. We have demonstrated that expression of the c-myc and c-Ha-ras protooncogenes is increased more than ten-fold in the contralateral kidney within 4 to 8 hr following unilateral nephrectomy in rats. The increased expression of these genes is analogous to the increased expression of c-myc and c-Ha-ras that occurs early in liver regeneration, preceding the first increase in DNA synthesis by at least 20 hr. In order to define the tissue specificity of the signals for compensatory renal hypertrophy, we also determined the early protooncogene response and the proliferative response in the liver of rats following unilateral nephrectomy. The expression of c-myc and c-Ha-ras was also increased (five- to ten-fold) in the livers of these animals. DNA synthesis was stimulated in the contralateral kidney at 26-30 hr following nephrectomy as measured by 3H thymidine incorporation, indicating a hyperplastic response to unilateral nephrectomy. However, there was no increase in DNA synthesis in the liver despite the dramatic increase in c-myc and c-Ha-ras expression. Our data suggest that the early increase in protooncogene expression in response to unilateral nephrectomy is stimulated by circulating signals that are not tissue-specific. Increased protooncogene expression in both kidney and liver following unilateral nephrectomy is an early response to the regenerative stimulus, but later signals must provide the tissue specificity necessary for regeneration and cellular proliferation.

Stimulation of protooncogene expression by partial hepatectomy is not tissue-specific.

We have characterized the early protooncogene response and the later cell proliferative response in the kidneys and livers of normal rats cross-circulated with partially hepatectomized animals. Increase c-myc and C-Ha-ras expression was observed in the kidneys of totally hepatectomized rats, as well as those of their cross-circulated partners. This indicates that the initial response to hepatectomy is not organ-specific, although the later DNA synthetic response of the kidney is only approximately one-tenth that of regenerating liver. Expression of c-myc and c-Ha-ras is dramatically increased in the livers of both hepatectomized and nonhepatectomized, parabiotic (cross-circulated) rats within 1 hr of partial hepatectomy, confirming the presence of a circulating factor which stimulates protooncogene expression early in regeneration. DNA synthesis was also stimulated in the livers of the cross-circulated animals between 20 and 26 hr following hepatectomy, but only to a level one-eighth that of the livers of hepatectomized animals. Normal rats cross-circulated with totally hepatectomized animals also demonstrated an early increase in hepatic c-myc and c-Ha-ras expression, indicating that regeneration must be stimulated by an extrahepatic signal. Our data suggest that the early increase in protooncogene expression is a non-organ-specific response to partial hepatectomy which does not insure subsequent cellular proliferation. The organ specificity of liver regeneration must involve an event separate from the early stimulation of protooncogene expression.