Surgical experience with hyperparathyroidism.

This is a retrospective analytic review of 208 patients with hyperparathyroidism studied and treated at Vanderbilt University Hospital from 1935 to 1980. Follow-up in these patients has been completed to date or to death in a great majority of patients. Results indicate the value of excision of isolated adenomas and of subtotal parathyroidectomy for primary and secondary hyperplasia.

Managed care, school health programs, and adolescent health services: opportunities for health promotion.

The rapid expansion of managed care creates opportunities and dilemmas for those involved in school health and adolescent health promotion. Managed care organizations (MCOs), public health agencies, and school and adolescent health providers share certain common goals and priorities including an emphasis on prevention, cost-effectiveness, and quality of care--and a willingness to explore innovative approaches to health promotion and disease prevention. However, MCOs often face conflicting challenges, balancing the goals of cost containment and investment in prevention. In considering support for school health programs, MCOs will be interested in evidence about the effectiveness of services in improving health and/or reducing medical expenditures. Mechanisms for improving prevention efforts within MCOs include quality assurance systems to monitor the performance of health plans, practice guidelines from professional organizations, and the contracting process between payers and health care providers. Development of partnerships between MCOs and schools will be a challenge given competing priorities, variation in managed care arrangements, structural differences between MCOs and schools, and variability in services provided by school health programs.

Kaposi's sarcoma in cyclosporine-induced gingival hyperplasia.

In the cases presented in this report, Kaposi's sarcoma developed in the gingiva of two patients with cyclosporine-induced gingival hyperplasia. The tumor was clinically inapparent, and was diagnosed unexpectedly following biopsy of the hypertrophied gingiva. This unusual presentation has not been reported previously.

Decreased salivary immunoglobulin A secretion rate after intense interval exercise in elite kayakers.

Endurance athletes have been shown to suffer a high incidence of upper respiratory tract infection (URTI; e.g. colds, sore throat) during intense training and after competition. Previous studies have shown that concentrations of secretory immunoglobulin A (IgA), the major effector of host defense against micro-organisms causing URTI, decrease after intense endurance exercise. Many athletes perform intense interval exercise as part of their normal training. The purpose of this study was to determine whether salivary IgA concentrations also decrease after intense interval exercise during the normal training regime in elite athletes. Timed saliva samples were obtained from eight elite male kayakers immediately before and after three on-water training sessions during a 3-week period. The concentrations of IgA, IgG and IgM were determined separately by enzyme-linked immunosorbent assay, and secretion rates calculated for each Ig. The IgA secretion rate (micrograms.min-1) decreased 27%-38% after all three training sessions (P = 0.007); the largest decrease (38%) was noted after the most intense session at the end of an especially intense week of training. The IgA concentration relative to total protein (micrograms.mg protein-1) was significantly lower (P < 0.05) on this training day compared with the other 2 days. Concentrations and secretion rates of IgG and IgM did not change after exercise, indicating a specific effect on IgA. These data would suggest that, in elite athletes, IgA concentration and secretion rate are reduced by intense interval exercise, and that exercise-induced changes in IgA output may be one mechanism contributing to URTI in elite athletes.

Effects of three tapering techniques on the performance, forces and psychometric measures of competitive swimmers.

The 100-m and 400-m swim time, tethered swimming forces, mood states and self-ratings of well-being of 27 competitive swimmers were measured before and after 4 weeks of intense training and after 1 week and 2 weeks of tapering for major competition. The swimmers were divided into three groups. Each group completed one of three taper regimes similar to those currently performed by swimmers in preparation for competition: (a) reduced training frequency according to each athlete's daily ratings of well-being, (b) reduced training volume, and (c) reduced training volume and intensity. Significant improvements in the Profile of Mood States measures of tension, depression and anger (P < 0.05) were observed after 1 week of tapering, with significant improvements in total mood disturbance and fatigue (P < 0.05) and peak tethered swimming force (P < 0.01) after 2 weeks. Non-significant improvements in 100-m and 400-m swim time (P > 0.05) were observed and no significant differences were revealed among the three tapering techniques. These data highlighted the importance of providing sufficient recovery before competition, since 1 week of reduced training was not long enough to maximise the benefits of tapering. However, none of the three types of tapering currently used by competitive swimmers could be shown to be more beneficial than the others.