Evaluation of seminal zinc levels by atomic absorption in men with spinal cord injury.

STUDY DESIGN: A case-control study evaluating seminal zinc level in spinal cord injury (SCI) patients. OBJECTIVES: Patients with SCI have neurological prostate dysfunction. There are only some indications in the literature that seminal zinc level may be lower in these patients. Seminal zinc is mainly produced by the prostate and, therefore, can be considered to be a marker of prostate function. The objective of the present study was to determine whether SCI can induce changes in seminal zinc levels and to compare the results with those obtained for normal men (controls). SETTING: The study was carried out in Brazil. METHODS: A total of 24 men with SCI (mean age±s.d. 36.25±10.24 years) and 24 controls (mean age±s.d. 36.50±10.31 years) were studied. Blood and semen were collected after 3 days of abstinence from ejaculation. Semen was left at room temperature for 15 min, stored in liquid nitrogen, and lyophilized. Seminal zinc was determined by atomic absorption. Blood was stored at a controlled temperature of - 70 to -79 °C and later used for the determination of testosterone, prolactin and total prostate-specific antigen using an AxSYM apparatus and Abbott reagents. RESULTS: Mean seminal zinc concentration was 85.20 mg l(-1) for the patients, a lower value than that obtained for the controls (147.16 mg l(-1)) (P=0.0035). CONCLUSION: Patients with SCI have a significant reduction of seminal zinc.

Evaluation of seminal citrate level by 1H nuclear magnetic resonance spectroscopy in men with spinal cord injury.

STUDY DESIGN: A case-control evaluating seminal citrate in patients with spinal cord injury (SCI). OBJECTIVE: Several studies have shown neurological prostatic dysfunction in patients with SCI, as confirmed by low levels of seminal prostate-specific antigen (PSA), which is used as a parameter of gland activity. However, seminal citrate, produced almost exclusively by the prostate, could also be used as a marker of prostate function. Thus, the objective of this study was to determine whether SCI causes any changes in seminal citrate concentration and to compare the results obtained for patients and healthy men (controls). SETTING: The study was carried out in Brazil. METHODS: We studied 30 men with SCI aged on average 37.77+/-10.04 years and 30 controls aged on average 38.03+/-10.06 years. Blood and semen samples were collected after 3 days of abstinence from ejaculation. Fifteen minutes after collection, semen was stored in liquid nitrogen and the samples were submitted to (1)H nuclear magnetic resonance ((1)H NMR). Serum was stored at a controlled temperature of -70 to -79 degrees C and later used for the determination of testosterone, prolactin and total PSA using an AxSYM instrument and Abbott reagents. RESULTS: The median concentration of seminal citrate was significantly lower in patients than in controls (521.65 versus 858.30 mg per 100 ml, P<0.001). CONCLUSIONS: Patients with SCI have a significant reduction of seminal citrate as a consequence of neurological dysfunction of the prostate.

The impact of regular vaginal pH screening on the diagnosis of bacterial vaginosis in pregnancy.

BACKGROUND: Bacterial vaginosis has recently been associated with preterm labor and delivery. The purpose of our study was to determine whether regular prenatal vaginal pH testing resulted in more frequent diagnoses of bacterial vaginosis and other vaginal infections, more frequent treatment with antibiotics, and fewer preterm deliveries. We also sought to determine the sensitivity and specificity of pH testing and vaginal symptom reporting in identifying vaginal infections. METHODS: Our study was a prospective clinical trial involving 121 pregnant women randomized to receive either standard prenatal care, including routine inquiry about vaginal symptoms, or standard care supplemented by vaginal pH testing. Women with symptoms or a vaginal pH level >4.5 received a wet mount examination. Confirmed infections were treated according to study protocols. RESULTS: Women who received regular pH testing showed significantly higher detection rates for bacterial vaginosis than controls (48.4% vs 27.1%, P =.015) and more frequent detection of Trichomonas vaginalis (7.8% vs 1.7%, P = .116). A higher percentage of women in the experimental group were treated for bacterial vaginosis and trichomoniasis (46.9% vs 27.1%, P =.024), and the preterm birth rate was one half that of the control group (4.7% vs 10.2%, P = .243). The presence of vaginal symptoms or a vaginal pH level >4.5 identified bacterial vaginosis or trichomoniasis with 84.4% sensitivity. CONCLUSIONS: In our study, frequent vaginal pH testing during pregnancy resulted in more frequent diagnosis and treatment of bacterial vaginosis. Since vaginal symptoms and elevated pH levels appear to be useful in screening for bacterial vaginosis and trichomoniasis, frequent pH testing should be evaluated in larger studies.

Clinical, pathological and therapeutic findings on lingual rhabdomyosarcoma in a dog - case report / Achados clínicos, patológicos e terapêuticos do rabdomiossarcoma em cão - relato de caso

The biological behaviour of the tumours vary according to the species in which they occur, its location within the cavity, clinical stage and histopathological nature. Lingual neoplasms are generally uncommon in companion animals. Rhabdomyosarcomas are malignant, solid, aggressive formations with high metastatic potential. The clinical signs are variable and a definitive diagnosis can only be reached through histopathological analysis of biopsy and necropsy specimen. In some cases, immunohistochemical study may be needed to confirm the diagnosis. This paper aims to highlight important points about this uncommon condition in dogs, using a case report of lingual rhabdomyosarcoma, which showed no evidence of metastasis after diagnosis, nor of local recurrence after surgical excision with a wide safety margin. It was concluded that early diagnosis, the correct interpretation of the complementary tests and the appropriate therapeutic approach contributed to improving the quality of life and survival of the patient in question.(AU)

O comportamento biológico dos tumores varia de acordo com a espécie animal, a localização na cavidade, a fase clínica e a natureza histopatológica. As neoplasias orais são geralmente incomuns em animais de companhia. Os rabdomiossarcomas são formações malignas, sólidas e agressivas, com alto potencial metastático. Os sinais clínicos são variáveis e o diagnóstico definitivo só pode ser alcançado por meio da análise histopatológica do material colhido. Em alguns casos, o estudo imuno-histoquímico pode ser necessário para confirmar o diagnóstico. Este trabalho tem como objetivo destacar pontos importantes sobre essa condição incomum em cães, utilizando um relato de caso de rabdomiossarcoma lingual, no qual não se evidenciaram metástases após o diagnóstico, nem recorrência local após a excisão cirúrgica com ampla margem de segurança. Concluiu-se que o diagnóstico precoce, a correta interpretação dos exames complementares e a abordagem terapêutica adequada contribuíram para melhorar a qualidade de vida e a sobrevida do paciente em questão.(AU)

Hallazgos en tomografia computada multidetector en el diagnóstico del carcinoma hepatocelular en pacientes con cirrosis y su correlación con la anatomia patológica del explante hepático / Findings in multidetector computed tomography in the diagnosis of hepatocellular carcinoma in patients with cirrhosis and correlation with pathology of liver explants

Objetivos: Describir el comportamiento imagenológico del hepatocarcinoma en pacientes con cirrosis utilizando la tomografía computada multidetector (TCMD) dinámica y correlacionar los hallazgos con el grado histológico de los tumores. Materiales y métodos: Estudio retrospectivo, observacional y descriptivo, donde se evaluaron 51 nódulos de 32 pacientes trasplantados de hígado con diagnóstico de cirrosis. La anatomía patológica del explante fue utilizada como referencia y los nódulos con histología de hepatocarcinoma fueron analizados retrospectivamente en las tomografías computadas efectuadas antes del trasplante. Las tomografías se llevaron a cabo con técnica dinámica, evaluando las características más frecuentes reportadas en la literatura: realce arterial, lavado del realce, cápsula y vasos arteriales intratumorales. Resultados: Cuarenta y seis de 51 (90%) tumores mostraron realce arterial. De estos 46 tumores, 39 (85%) mostraron lavado del realce en la fase portal y/o tardía. De los 51, 5 (10%) fueron hipovasculares, 22 (43%) presentaron cápsula y 12 (24%) mostraron vasos arteriales intratumorales. La combinación de hallazgos más frecuente fue la asociación de realce arterial y lavado del realce en la fase portal-tardía (39/51 tumores: 76%), y el grado histológico más usual fue el II en 35 tumores (69%). Se hallaron asociaciones estadísticamente significativas entre el grado histológico de los tumores y los comportamientos imagenológicos realce arterial e hipovascular. Conclusión: En nuestra población, el hallazgo tomográfico de realce arterial con lavado del realce en tiempo portal y/o tardío fue observado en la mayoría de los tumores. Esto coincide con publicaciones anteriores y contribuye a fortalecer el valor de estos criterios para el diagnóstico del hepatocarcinoma.(AU)

Objectives: To describe the imagenological behavior of hepatocellular carcinoma in cirrhotic patients using a dynamic multidetector computed tomography (MDCT) technique, and correlate these fi ndings with histological tumor grades. Materials and methods: A retrospective, descriptive observational study was conducted to evaluate 51 nodules in 32 liver transplant patients diagnosed with liver cirrhosis. The pathology of liver explants was used as a reference. Nodules with hepatocellular carcinoma histopathology were retrospectively analyzed by computed tomography scans performed pre-transplant. Using a dynamic multidetector computed tomography technique, we evaluated the mos common imagenological behavior reported in the literature: arterial enhancement, washout, capsule, and intratumoral arterial vessels. Results: Forty-six of 51 (90%) tumors showed arterial enhancement. Of the 46 tumors with arterial enhancement, 39 (85%) had washout in portal-late phase. Five of 51 (10%) were hypovascular. Twenty-two of 51 (43%) had capsule and 12 of 51 (24%) showed intratumoral arterial vessels. The more frequent image combination was the combination of arterial enhancement and washout (39 of 51 tumors or 76%). The most frequent histological grade was II (35 of 51 tumors or 69%). Statistically signifi cant relationships were found between histological grade tumors and imagenological behavior: arterial enhancement and hypovascular. Conclusion: In our population, arterial enhancement with washout in portal-late phases was observed in most of the tumors. Our results are consistent with previously reported studies, demonstrating the high reliability of this imaging pattern for the diagnosis of hepatocellular carcinoma.(AU)

Hallazgos en tomografía computada multidetector en el diagnóstico del carcinoma hepatocelular en pacientes con cirrosis y su correlación con la anatomía patológica del explante hepático / Findings in multidetector computed tomography in the diagnosis of hepatocellular carcinoma in patients with cirrhosis and correlation with pathology of liver explants

Objetivos: Describir el comportamiento imagenológico del hepatocarcinoma en pacientes con cirrosis utilizando la tomografía computada multidetector (TCMD) dinámica y correlacionar los hallazgos con el grado histológico de los tumores. Materiales y métodos: Estudio retrospectivo, observacional y descriptivo, donde se evaluaron 51 nódulos de 32 pacientes trasplantados de hígado con diagnóstico de cirrosis. La anatomía patológica del explante fue utilizada como referencia y los nódulos con histología de hepatocarcinoma fueron analizados retrospectivamente en las tomografías computadas efectuadas antes del trasplante. Las tomografías se llevaron a cabo con técnica dinámica, evaluando las características más frecuentes reportadas en la literatura: realce arterial, lavado del realce, cápsula y vasos arteriales intratumorales. Resultados: Cuarenta y seis de 51 (90%) tumores mostraron realce arterial. De estos 46 tumores, 39 (85%) mostraron lavado del realce en la fase portal y/o tardía. De los 51, 5 (10%) fueron hipovasculares, 22 (43%) presentaron cápsula y 12 (24%) mostraron vasos arteriales intratumorales. La combinación de hallazgos más frecuente fue la asociación de realce arterial y lavado del realce en la fase portal-tardía (39/51 tumores: 76%), y el grado histológico más usual fue el II en 35 tumores (69%). Se hallaron asociaciones estadísticamente significativas entre el grado histológico de los tumores y los comportamientos imagenológicos realce arterial e hipovascular. Conclusión: En nuestra población, el hallazgo tomográfico de realce arterial con lavado del realce en tiempo portal y/o tardío fue observado en la mayoría de los tumores. Esto coincide con publicaciones anteriores y contribuye a fortalecer el valor de estos criterios para el diagnóstico del hepatocarcinoma...

Objectives: To describe the imagenological behavior of hepatocellular carcinoma in cirrhotic patients using a dynamic multidetector computed tomography (MDCT) technique, and correlate these fi ndings with histological tumor grades.Materials and methods: A retrospective, descriptive observational study was conducted to evaluate 51 nodules in 32 liver transplant patients diagnosed with liver cirrhosis. The pathology of liver explants was used as a reference. Nodules with hepatocellular carcinoma histopathology were retrospectively analyzed by computed tomography scans performed pre-transplant. Using a dynamic multidetector computed tomography technique, we evaluated the mos common imagenological behavior reported in the literature: arterial enhancement, washout, capsule, and intratumoral arterial vessels.Results: Forty-six of 51 (90%) tumors showed arterial enhancement. Of the 46 tumors with arterial enhancement, 39 (85%) had washout in portal-late phase. Five of 51 (10%) were hypovascular. Twenty-two of 51 (43%) had capsule and 12 of 51 (24%) showed intratumoral arterial vessels. The more frequent image combination was the combination of arterial enhancement and washout (39 of 51 tumors or 76%). The most frequent histological grade was II (35 of 51 tumors or 69%). Statistically signifi cant relationships were found between histological grade tumors and imagenological behavior: arterial enhancement and hypovascular. Conclusion: In our population, arterial enhancement with washout in portal-late phases was observed in most of the tumors. Our results are consistent with previously reported studies, demonstrating the high reliability of this imaging pattern for the diagnosis of hepatocellular carcinoma...

Diagnosis and treatment of abdominal aortic aneurysms.

Abdominal aortic aneurysms occur in 5 to 7 percent of people over age 60 in the United States. An aneurysm is defined as a permanent localized dilatation of an artery, with an increase in diameter of greater than 1.5 times its normal diameter. Abdominal aortic aneurysms may be manifested by catastrophic rupture, signs of pressure on other viscera or an embolism originating in the aneurysmal wall, but most cases are asymptomatic. The diagnosis is often made by physical examination of the abdomen, which reveals a pulsatile mass left of the midline, between the xyphoid process and the umbilicus. The diagnosis may be confirmed by B-mode ultrasound. Ultrasound screening should be considered for individuals at risk for abdominal aortic aneurysms. This group includes individuals over age 60 who smoke, have hypertension or have vascular disease. Elective surgical intervention is indicated for most patients with abdominal aortic aneurysms greater than 5 cm in diameter to prevent rupture and death. Smaller abdominal aortic aneurysms should be monitored by regular ultrasound measurements. Screening and identification of abdominal aortic aneurysms by primary care physicians can have a significant impact on patient survival.

Chronic critical limb ischemia: diagnosis, treatment and prognosis.

Chronic critical limb ischemia is manifested by pain at rest, nonhealing wounds and gangrene. Ischemic rest pain is typically described as a burning pain in the arch or distal foot that occurs while the patient is recumbent but is relieved when the patient returns to a position in which the feet are dependent. Objective hemodynamic parameters that support the diagnosis of critical limb ischemia include an ankle-brachial index of 0.4 or less, an ankle systolic pressure of 50 mm Hg or less, or a toe systolic pressure of 30 mm Hg or less. Intervention may include conservative therapy, revascularization or amputation. Progressive gangrene, rapidly enlarging wounds or continuous ischemic rest pain can signify a threat to the limb and suggest the need for revascularization in patients without prohibitive operative risks. Bypass grafts are usually required because of the multilevel and distal nature of the arterial narrowing in critical limb ischemia. Patients with diabetes are more likely than other patients to have distal disease that is less amenable to bypass grafting. Compared with amputation, revascularization is more cost-effective and is associated with better perioperative morbidity and mortality. Limb preservation should be the goal in most patients with critical limb ischemia.

The significance of the spores of the Basidiomycetes (mushrooms and their allies) in bronchial asthma and allergic rhinitis.

The role of Basidiospores in the allergic diathesis is poorly understood. Dialyzed extracts of Agaricus campestris, Coprinus micaceus, Fuligo septica, Lycoperdon perlatum, Scleroderma lycoperdoides, Ustilago maydis, and sooty mold were prepared from fresh spores. The study group consisted of 100 patients with asthma and 100 patients with allergic rhinitis. These 200 patients had symptoms occurring during October and November. All were intradermally skin tested with the seven extracts at concentrations of 1 microgram/mL or 10 micrograms/mL. No scratch or pressure puncture tests were performed. Skin tests were recorded at 15 minutes (pos = 5-mm wheal with 10-mm erythema or greater) and at six or 24 hours (pos = 6 mm or greater of induration and erythema). A total of 436 immediate reactions were observed in the asthmatic group (4.4/patient) compared with 129 in the rhinitic group (1.3/patient). The late phase reactions were just the opposite. The asthmatic group had 66 late phase reactions or 0.7/patient compared with 382 or 3.8/patient in the rhinitic group. This study demonstrates that patients with bronchial asthma have a higher incidence of immediate skin sensitivity by intradermal testing, whereas patients with allergic rhinitis have late phase sensitivity to these fungal spores. This study was performed in the eastern United States only; therefore, the clinical significance of the results will become more apparent once this study is repeated in other parts of the country by other investigators.

Patients receiving immunotherapy report it is effective as assessed by the rhinitis outcomes questionnaire (ROQ) in a private practice setting.

BACKGROUND: Outcomes measurement is a proficient method in determining the effectiveness of medical therapy. Currently, there are no easy-to-use and inexpensive questionnaires available to evaluate the effectiveness of immunotherapy by allergists in private practice. OBJECTIVE: To evaluate the effectiveness of immunotherapy in the treatment of patients with allergic rhinitis in a private practice setting using the rhinitis outcomes questionnaire (ROQ). METHODS: One hundred seventy-five patients were randomly chosen from three private practices nationwide. They were surveyed regarding global systemic problems and nasal, eye, and chest symptoms, as well as their medical treatment history. This questionnaire was administered twice in one sitting, with the first a recall of symptoms before immunotherapy treatment, and the second an evaluation of current symptoms. RESULTS: The data revealed that 81% of the patients believed immunotherapy worked, with 19% unsure. Patients experienced a 67% decrease in antibiotic use, a 68% decrease in emergency room visits, a 75% decrease in days lost from work or school, and a 79% decrease in hospital admissions. The average symptom score reduction with immunotherapy was 52%. CONCLUSIONS: This study demonstrates that the user-friendly ROQ can be effectively and inexpensively used in a private practice setting and that immunotherapy is effective in the treatment of allergic rhinitis.

Individual patterns of immediate skin reactivity to mold extracts.

One hundred atopic patients were skin tested intradermally over a 2-year period with 30 different mold extracts. Subjects were monitored for immediate reactions. Data suggest that to evaluate mold sensitivity in atopic patients one must use multiple mold extracts.

Prevention of stroke caused by carotid bifurcation stenosis.

Prevention of stroke caused by carotid bifurcation stenosis can be achieved by accurate identification and evaluation of patients at risk. A consensus report from the National Institute of Neurologic Disorders and Stroke has standardized diagnostic criteria and symptoms related to this disease. Recent prospective, randomized trials have identified effective treatment for both asymptomatic and symptomatic carotid stenosis. The risk factors for carotid stenosis are similar to those for atherosclerosis--hypertension, diabetes, cigarette smoking and hyperlipidemia. A carotid bruit is the most common clinical finding, although its positive predictive value is only about 60 to 70 percent. Recent clinical trials have identified patient groups that benefit from surgical and medical therapy, depending on the degree of carotid stenosis and the presence or absence of symptoms. Symptomatic patients with carotid stenosis greater than 70 percent benefit from surgical therapy. Asymptomatic patients who have carotid stenosis greater than 60 percent and are good surgical candidates should be referred for surgical consultation.

Claudication: diagnosis and treatment.

Claudication is exercise-induced lower extremity pain that is caused by ischemia and relieved by rest. This underreported condition affects at least 10 percent of persons over 70 years of age and 2 percent of those 37 to 69 years of age. Claudication is usually caused by atherosclerotic narrowing of the arteries that supply blood to the lower extremities. The diagnosis may be suspected based on the history and the physical examination, and it is confirmed by Doppler segmental pressures and an ankle/brachial index. Initial treatment includes vigorous risk factor modification and an exercise program. Further treatment includes pentoxifylline and, occasionally, endovascular or bypass procedures.

Preparation of carbon-14-labelled whole short ragweed pollen antigens.

A new method of labelling short ragweed pollen antigens with carbon-14 is described. The known ragweed antigens AgE, Ra3, Ra5 and several other antigens are radiolabelled. These components are biologically active, have a high specific radioactivity and a long half-life.

Validation of the rhinitis outcomes questionnaire (ROQ).

BACKGROUND: Currently, there is no easy-to-use and comprehensive questionnaire that measures the effectiveness of treatment of rhinitis-related symptoms in a private practice setting. OBJECTIVE: To validate a brief, effective, self-administered rhinitis symptoms questionnaire that can easily be used in a private practice setting for tracking treatment outcomes. METHODS: One hundred seventy-five patients were randomly chosen from three private practices nationwide and were surveyed regarding systemic problems, nasal, eye, and chest symptoms, as well as medical treatment obtained. This survey was administered twice in one sitting with the first administration a recall of symptoms before immunotherapy, and the second administration an evaluation of current symptoms. Appropriate statistical methods were used to evaluate the validity, reliability, and responsiveness of the questionnaire presented. The validation of this instrument included content, statistical, construct, and predictive validity. RESULTS: Both the content and statistical validity were very good in that the questionnaire was easily understood and covered required domains. Construct validity revealed that the items were sensibly related to the domains that contained them and had less association with items from different domains. The reliability of the scales was very good (Cronbach's alpha = 0.80) to outstanding (Cronbach's alpha = 0.92). CONCLUSIONS: Functionality was established for the rhinitis outcomes questionnaire (ROQ) for use in a private practice setting. This allows private practice allergists to collect reliable data with the ROQ.

HLA-B7 cross-reacting group and human IgE-mediated sensitivity to ragweed allergen Ra5.

HLA typing and cutaneous testing for allergen sensitivity of 76 ragweed allergic patients confirmed previous findings of a significant association between sensitivity to ragweed allergen Ra5 and possession of one or other of the HLA-B7 cross-reacting group of antigens.

Skin reactivity to purified pollen allergens in highly ragweed-sensitive individuals.

Five hundred twenty-five atopic patients were skin tested over a 12-mo period to several crude allergens with a puncture skin-testing technique utilizing a bifurcated needle originally developed for smallpox immunization. Of these, 122 were highly allergic to short ragweed pollen and were subsequently tested with a series of purified grass and ragweed allergens. Data of their reactivity to these allergens is presented, and the phenomenon that each patient has a unique "allergic fingerprint" to purified pollen allergens is shown. The puncture technique showed good correlation with quantitative intradermal skin titration and offered a definite advantage, because many allergens could be rapidly and accurately assayed with good patient compliance.

A randomized, prospective evaluation of the Tesio, Ash split, and Opti-flow hemodialysis catheters.

PURPOSE: A randomized, prospective evaluation of three high-flow hemodialysis catheters. MATERIALS AND METHODS: Ninety-four patients were randomly assigned 113 Tesio, Ash split, and Opti-flow catheters from December 1998 through June 1999. Insertion times, procedural complications, and ease of insertion were recorded. Mean catheter flow rates were recorded at first dialysis, 30 days, and 90 days. Patency, catheter survival, and catheter-related infections were evaluated. RESULTS: Thirty-eight Ash split, 39 Opti-flow, and 36 Tesio catheters were placed. Tesio mean insertion time (41.5 min) was significantly longer than Ash split (29.4 min) or Opti-flow (29.6 min) (P =.004). There were four complications related to Tesio catheters (three cases of pericatheter bleeding, one air embolism), one related to an Opti-flow catheter (pericatheter bleeding), and zero related to Ash split catheters. Opti-flow and Ash split catheters were significantly easier to insert than Tesio catheters (P =.041). Mean flow rates were not significantly different among the catheters initially (P =.112), at 30 days (P =.281), or at 90 days (P =.112). Catheter-related infection rates per 100 catheter days were 0.12 for Ash split, 0.35 for Opti-flow, and 0.14 for TESIO: Median catheter survival was 302 days for Ash split, 176 days for Opti-flow, and 228 days for TESIO: CONCLUSIONS: Opti-Flow and Ash split catheters were faster and easier to place than Tesio catheters. There was no difference in hemodialysis flow rates or catheter survival.