Prevalence of bone demineralization in the United States.

A study of the distribution and prevalence of bone demineralization in the US population is reported. Based on the HANES I Survey data that incorporated bone density examination of V-2 by the Goldsmith and Vose techniques in a national sample of 6030 adults, it was observed that (1) age-adjusted bone density differences between sexes were consistently found when controlling for race (the prevalence of low bone density was greater among females than males) and (2) whites of both sexes had higher prevalence of low density than blacks in most age-sex categories.

Psoas muscle abscess due to Yersinia enterocolitica.

A psoas muscle abscess due to Yersinia enterocolitica developed in a 71-year-old man with mild type II diabetes mellitus. There was no evidence of gastrointestinal infection or septicemia, and treatment with computed tomography-directed percutaneous drainage and cefoxitin resulted in cure. This represents the first known reported case of psoas abscess due to Y. enterocolitica.

Risk of hospitalization because of aseptic meningitis after measles-mumps-rubella vaccination in one- to two-year-old children: an analysis of the Vaccine Safety Datalink (VSD) Project.

OBJECTIVE: To assess the level of increased risk, if any, of hospitalizations for aseptic meningitis after Jeryl-Lynn mumps strain measles-mumps-rubella (MMR) vaccine in the Vaccine Safety Datalink population. STUDY DESIGN: A possible increased risk of aseptic meningitis 8 to 14 days after receipt of MMR was observed in a preliminary screening analysis of automated data from the Vaccine Safety Datalink (VSD) project Year 2 analysis. To further evaluate this association a retrospective 10-year matched case-control study was undertaken in the four health maintenance organizations (HMOs) in the VSD project. Cases ascertained from a broad scan of the automated data were validated against a standard case definition. Two controls matched on age, sex, HMO and HMO membership were assigned per case. RESULTS: The VSD project involves the cooperative collection of automated vaccination and medical outcome data from four large HMOs that currently have 500,000 children younger than 7 years of age under surveillance. Review of automated screening results from the first 2 years of data revealed a possible increased risk of aseptic meningitis 0 to 14 days after MMR with a relative risk of 3.61 (95% confidence interval, 1.0 to 13.1) although the total number of cases was small. Although the automated data had suggested a possible association of aseptic meningitis with MMR containing the Jeryl-Lynn strain of mumps, review of validated hospitalized cases during the observation period did not reveal evidence of an increased risk of aseptic meningitis after MMR containing the Jeryl-Lynn strain of mumps (odds ratio < 1.0 for all analyses). CONCLUSION: Although it is recognized that hospitalized cases represent a minority of the total cases of aseptic meningitis, it is reassuring that in this evaluation no increased risk of aseptic meningitis after MMR vaccine was found.

Thyroid function tests in elderly hyperthyroid patients.

Several tests of thyroid function were performed in 35 hyperthyroid patients over the age of 65 (elderly). The results were compared to those of similar tests in 48 hyperthyroid patients under the age of 65 (young). Total serum thyroxine (T4) was within the normal range in 14 percent of the elderly and 11 percent of the young hyperthyroid patients. The free thyroxine index (FTI) was within the normal range in 11 percent of both groups. The triiodothyronine uptake (T3U) proved to be a poor test in both groups. Although elevation of the triiodothyronine (T3) level allowed a diagnosis of "T3-toxicosis" in 2 elderly and 3 young hyperthyroid patients, the T3 level was normal in 34 percent of the elderly and 13 percent of the young subjects. Correction of the T3 range for age reduced the number of normal T3 values to 12.5 percent in the elderly hyperthyroid patients. The 24-hour uptake of radioactive iodine was normal in 12 percent of the young hyperthyroid patients, 27 percent of the elderly patients with Graves' disease, and 70 percent of the elderly patients with toxic nodular goiter, despite recent readjustment of the normal range for the test. It is concluded that the diagnosis of hyperthyroidism in the elderly may be difficult and that no single test can be relied upon to exclude the diagnosis.

Serum concentrations of the iodothyronines in elderly subjects: decreased triiodothyronine (T3) and free T3 index.

In four groups of subjects free of thyroid disease, the following determinations were made: serum concentrations of thyroxine (T4), triiodothyronine (T3), reverse T3(rT3) and diiodothyronine (T2), and calculated indices of free thyroxine (FT4) and free triiodothyronine (FT3). Group A comprised healthy subjects aged 16-64; Group B, 24 healthy elderly subjects aged 68-95; Group C, 23 elderly patients with mild well-controlled chronic illnesses, aged 70-85; Group D, 40 nursing home residents aged 66-100. Serum T4 and T2 concentrations and the FT4 index were not affected by age; the rT3 concentration was slightly but significantly elevated only in Group D patients. Serum T3 concentration was significantly lower in all groups of elderly subjects and decreased FT3 index measurements were detected after age 75. It was concluded that old age, without complicating illness, is accompanied only by a decrease in the serum level of T3 and the FT3 index; values for other iodothyronines are unchanged. Clinicians should consider the age-related changes in T3 and FT3 values when interpreting thyroid function tests.

Paratesticular desmoid tumor.

A primary intrascrotal mass clinically mimicking a testicular tumor was found to be a desmoid tumor originating from the spermatic cord. To our knowledge, this is the first reported case of a paratesticular desmoid tumor.

Ureteral obstruction in a patient with Burkitt's lymphoma and AIDS.

Burkitt's lymphoma presenting as an intrinsic ureteral mass is rare. We report on an immunocompromised patient with hydronephrosis secondary to direct involvement of the ureter by this non-Hodgkin's lymphoma. This case illustrates one of the manifestations of AIDS and the treatment of this manifestation. The relationship of AIDS and its sequela to the genitourinary system is discussed.

Stage A prostate cancer from pathologist's viewpoint.

Four hundred sixty-five departments of pathology in the United States were asked the following questions pertaining to Stage A prostatic cancer: (1) If a focus of adenocarcinoma is incidentally found in an enucleated specimen, what is the maximum diameter such a lesion may attain and still be considered an A-1 prostatic carcinoma? (2) If adenocarcinoma is incidentally found in a specimen resected transurethrally, how many chips may contain tumor and the lesion still be considered A-1 prostatic carcinoma? (3) What is your "routine pathologic examination" of a prostatic specimen? The majority of pathologists believe that the maximum diameter of a focal (A-1) lesion in an enucleated specimen is 5 mm., and the maximum number of transurethral chips containing tumor in a focal (A-1) lesion is three. The majority of pathologists section every chip when the specimen weighs less than 10 Gm. However, only 12 per cent of the pathologists section every chip when the specimen is greater than 10 Gm., while the others use a random section technique. There is a great diversity of techniques among pathologists in their methods of examining enucleated prostatic specimens.

Ectopic duplicated ureter opening into ipsilateral vas deferens.

A case of a duplicated collecting system with an ectopic ureter draining into the ipsilateral vas deferens is presented. The embryology of this entity is reviewed.

Effects of ultrasound on ultrastructure of human testes.

Studies to detect ultrastructural changes in testicular tissues after a fifteen-minute exposure to ultrasonic waves were done in 10 men undergoing bilateral orchiectomies for prostatic carcinoma. Examination of Sertoli cells and germ cells in different stages of differentiation failed to reveal significant differences between exposed and control testes.

The Houston Vision Assessment Test (HVAT): an assessment of validity. The Cataract Outcome Study Group.

PURPOSE: Cataract surgery is one of the most successful procedures in medicine, and outcome is typically measured by a single factor - improvement in visual acuity. Health-related functional outcome testing, which quantifies the patient's self-reported perception of impairment, can be integrated with objective clinical findings. Based on the patient's self-assessed lifestyle impairment, the physician and patient together can make an informed decision on the treatment that is most likely to benefit the patient. METHOD: A functional outcome test (the Houston Vision Assessment Test - HVAT, copyrighted 1990, 1992) was evaluated in a cataract population of 149 patients from seven study centers. Test results were correlated with objective ophthalmic endpoints. The HVAT divides an estimated total impairment into subcomponents of Visual Impairment (correctable by cataract surgery) and non-visual Physical Impairments (co-morbidities not affected by cataract surgery). RESULTS: In this prospective study, the average Visual Impairment score improved by 19 points (65%) following cataract extraction (the mean HVAT Visual Impairment score was 29 points before surgery and 10 points at 5 months post-surgery, a change of 65%). Physical Impairment remained unchanged by surgery. Visual acuity was a poor predictor of Visual Impairment. CONCLUSIONS: The HVAT has 11 simple questions. It may be self-administered and is available on the Internet: http://www.DHAC.com. The physician may err if his decision in favor of cataract surgery is based only on visual acuity. The HVAT has the potential to guide the decision-making process between patient and physician.

Catastrophic health insurance and HMO's.

The catastrophic health insurance bills introduced during the 96th U.S. Congress failed to consider the current role that Health Maintenance Organizations (HMO's) play in providing catastrophic protection and the potential negative impact such legislation may have on their competitive position. This article demonstrates that HMO's are providing this coverage by using the simulated health care expenditures for families in one HMO. The estimated proportion of families that incur catastrophic expenditures varies from 0.3 to 14.4% depending on the definition used for catastrophic. The paper closes with a discussion of the potential adverse impact that the legislation would have had on HMO's.

Emerging and reemerging infectious diseases: a multidisciplinary perspective.

Predictions that infectious diseases would be eliminated as a major threat to human health have been shattered by emerging and reemerging infections, among them acquired immunodeficiency syndrome (AIDS), hemorrhagic fevers, marked increases in infections caused by antimicrobial-resistant bacteria, and the resurgence of tuberculosis and malaria. Understanding the dynamics of emerging and reemerging infections is critical to efforts to reduce the morbidity and mortality of such infections, to establish policy related to preparedness for infectious threats, and for decisions on where to use limited resources in the fight against infections. In order to offer a multidisciplinary perspective, 23 infectious disease specialists, epidemiologists, geneticists, microbiologists, and population biologists participated in an open forum at Emory University on emerging and reemerging infectious diseases. As summarized below, the group addressed questions about the definition, the identification, the factors responsible for, and multidisciplinary approaches to emerging and reemerging infections.

Lightning risk.

Since 1969, ninety-four persons were reportedly killed annually by lightning in the United States. Reported injuries were almost three times the fatalities. These casualties were not evenly distributed across the country. The purpose of this paper was to examine the expected distribution of these occurrences using known ecologic risk factors. Lightning fatalities and injuries were related to thunderstorm days, population characteristics, and land area. The resulting predicted casualties were mapped and indicate where preventive measures are needed. This same technique could be employed to examine most natural hazard risks using existing data.

The aims and methods of technology assessment.

Technology Assessment (T.A.) is viewed as a dynamic process. The paper emphasizes the basic aims of T.A. as an assessment and synthesis process. Specific areas of system analysis and the tracking of technology are presented with respect to T.A. priorities, stage of development, and the collateral use of the basic techniques of quantitative analysis in the context of community health. An information system, in conjunction with the role of new approaches to T.A. such as Meta-Analysis are discussed. Several examples from the literature are presented by way of illustration.

Medical technology assessment: adequate questions, appropriate methods, valuable answers.

Medical Technology Assessment begins with carefully posing the appropriate questions to be examined. Specification of the critical assessment provides the framework for the design to provide the answers. This paper addresses the Technology Assessment process as a sequence of the above steps. The practical requisites of the diversity of questions, the economic, and study design considerations generated are addressed in a systems analysis model of input-process-outcome. Applications and the relative merits of such design consideration are discussed and illustrated. The questions related to medical technologies may come from different groups of people directly or indirectly interested, and having active or passive relationship to a given technology. There are 4 basic issues from which the detailed questions derive. These are the issues of need, effectiveness, safety and cost. The timing of asking questions in the life-cycle of a technology and the adequacy of the answers determines the choice of methods, the extent of an evaluation and the quality of the responses. The reliability, external validity, generalizability, and the clarity of conclusions are the characteristics of a practical and valuable assessment.

Assessing hospital nursing staff retention and turnover. A life table approach.

This research applied the life table technique to nursing personnel data in two types of hospitals to illustrate how administrators can examine patterns of continued employment. Although a large proportion of nurses were short-stay employees, the teaching hospital was found to have a higher retention rate than the community hospital corporation. The retention patterns are examined by personal and professional characteristics, as well as by reason for termination. Implications of our findings are discussed with respect to policy concerns related to hiring, retention, productivity, and staff development.

Dental care for handicapped children reexamined: I. Dental training and treatment of the handicapped.

1) Training experience is closely related to whether or not handicapped children are treated. If practitioners attended a postgraduate pedodontic training program, or received classroom education or clinical training in the treatment of handicapped children, they are much more likely to treat such patients. (Worth noting is the fact that one fourth of the pedodontists treating handicapped children had not received postgraduate pedodontic training and 20-30 percent reported no training on the treatment of such patients at all.) 2) Slightly less than half of the general practitioners and 96 percent of the pedodontists surveyed report that they currently treat the dental problems of handicapped children. 3) Practitioners currently treating handicapped children report treating more such patients during their dental training and are more likely to feel that they received sufficient exposure to these patients during their training. (Twenty percent of the general practitioners and 53 percent of the pedodontists felt they had sufficient exposure.) 4) Dentists treating handicapped children were more likely to report both classroom education and clinical training about the use of multidisciplinary health manpower in the treatment of their patients, and to report using such personnel as consultants in their dental practice.

Skp-cullin-F box E3 ligase component FBXL2 ubiquitinates Aurora B to inhibit tumorigenesis.

Aurora B kinase is an integral regulator of cytokinesis, as it stabilizes the intercellular canal within the midbody to ensure proper chromosomal segregation during cell division. Here we identified that the ubiquitin E3 ligase complex SCF(FBXL2) mediates Aurora B ubiquitination and degradation within the midbody, which is sufficient to induce mitotic arrest and apoptosis. Three molecular acceptor sites (K¹°², K¹°³ and K²°7) within Aurora B protein were identified as important sites for its ubiquitination. A triple Lys mutant of Aurora B (K¹°²/¹°³/(²°7R)) exhibited optimal resistance to SCF(FBXL2)-directed polyubiquitination, and overexpression of this variant resulted in a significant delay in anaphase onset, resulting in apoptosis. A unique small molecule F-box/LRR-repeat protein 2 (FBXL2) activator, BC-1258, stabilized and increased levels of FBXL2 protein that promoted Aurora B degradation, resulting in tetraploidy, mitotic arrest and apoptosis of tumorigenic cells, and profoundly inhibiting tumor formation in athymic nude mice. These findings uncover a new proteolytic mechanism targeting a key regulator of cell replication that may serve as a basis for chemotherapeutic intervention in neoplasia.

F-box protein FBXL2 exerts human lung tumor suppressor-like activity by ubiquitin-mediated degradation of cyclin D3 resulting in cell cycle arrest.

Dysregulated behavior of cell cycle proteins and their control by ubiquitin E3 ligases is an emerging theme in human lung cancer. Here, we identified and characterized the activity of a novel F-box protein, termed FBXL2, belonging to the SCF (Skip-Cullin1-F-box protein) E3 ligase family. Ectopically expressed FBXL2 triggered G2/M-phase arrest, induced chromosomal anomalies and increased apoptosis of transformed lung epithelia by mediating polyubiquitination and degradation of the mitotic regulator, cyclin D3. Unlike other F-box proteins that target phosphodegrons within substrates, FBXL2 uniquely recognizes a canonical calmodulin (CaM)-binding motif within cyclin D3 to facilitate its polyubiquitination. CaM bound and protected cyclin D3 from FBXL2 by direct intermolecular competition with the F-box protein for access within this motif. The chemotherapeutic agent vinorelbine increased apoptosis of human lung carcinoma cells by inducing FBXL2 expression and cyclin D3 degradation, an effect accentuated by CaM knockdown. Depletion of endogenous FBXL2 stabilized cyclin D3 levels, accelerated cancer cell growth and increased cell viability after vinorelbine treatment. Last, ectopic expression of FBXL2 significantly inhibited the growth and migration of tumorogenic cells and tumor formation in athymic nude mice. These observations implicate SCF(FBXL2) as an indispensible regulator of mitosis that serves as a tumor suppressor.