Oxybutynin: dry days for patients with hyperhidrosis.

We report the case of a 56-year-old postmenopausal woman who was referred to our Endocrinology Outpatient Clinic because of severe hyperhidrosis. She had a four-year history of excessive sweating of her face and upper body. On presentation no sweating could be documented. Physical examination was also unremarkable. It appeared that five days earlier her general practitioner had prescribed oxybutynin for urge incontinence and this accidentally cured her hyperhidrosis. She was diagnosed with idiopathic hyperhidrosis. We advised her to continue the oxybutynin and six months later, she was still symptom-free. Oral anticholinergic drugs are known to be effective for hyperhidrosis, but only anecdotal reports on oxybutynin can be found in the literature. Oxybutynin is not approved for hyperhidrosis, explaining the unfamiliarity with this medicine. This case shows that oxybutynin can be a very effective and simple treatment with only mild side effects. Therefore, oxybutynin merits consideration in patients with idiopathic hyperhidrosis. This report includes a concise review of the causes and treatment options of hyperhidrosis.

[Relationship between the use of postgraduate educational material on human immunodeficiency virus and the number of HIV consultations in family practice]. / Samenhang tussen het gebruik van nascholingsmateriaal over het humaan immunodeficiëntievirus en het aantal HIV-consulten in huisartspraktijken.

An enquiry using a structured questionnaire was conducted among all 6300 GPs in the Netherlands in order to assess the distribution of HIV-related problems over general practices in the Netherlands and the influence on it of the use of the 'HIV-wijzer voor de huisarts', a loose-leaf handbook on HIV, distributed since 1988 among all Dutch general practitioners. The enquiry was conducted one year after its publication. The 2156 respondents (34%) appeared to be reasonably representative of all GPs. The results show minor imperfections because a small proportion of the questionnaires was filled out incompletely. Almost 90% of respondents mentioned HIV-related consultations, 24% had HIV-seropositive patients and 18% had AIDS patients. These numbers were correlated mainly with municipality size, less with region. The use of the 'HIV-wijzer' was related to occurrence of HIV-related consultations and AIDS patients in a practice. GPs who do not encounter these problems are little motivated to read the 'HIV-wijzer'. For them, other means of education have to be developed or HIV has to be included in existing education programmes on other subjects.

[Reliability of assessment of audible stuttering behavior]. / Verlässlichkeit der Beurteilung hörbaren Stotterverhaltens.

The authors examine the essential aspects of the behaviour of the stutterer as perceived by the ear and discuss the reliability of the appreciation. The method of molecular analysis of speech samples of children aged from 7 to 12 years is described. The conclusion is that using this method, four out of the six categories of children examined show complete concordance and can be repeated as required; this is particularly true insofar as elongations, blockages, repetitions and interjections are concerned. However, one cannot consider as valid criteria the length of the pauses and the quality of breathing during phonation.

(De)regulation of key enzyme steps in the shikimate pathway and phenylalanine-specific pathway of the actinomycete Amycolatopsis methanolica.

Prephenate dehydratase (PDT), chorismate mutase (CM) and 3-deoxy-D-arabino-7-heptulosonate 7-phosphate (DAHP) synthase are key regulatory enzymes in aromatic amino acid biosynthesis in the actinomycete Amycolatopsis methanolica. Deregulated, feedback-control-resistant mutants were isolated by incubation of A. methanolica on glucose mineral agar containing the toxic analogue p-fluoro-DL-phenylalanine (pFPhe). Several of these mutants had completely lost PDT sensitivity to Phe inhibition and Tyr activation. Mutant characterization yielded new information about PDT amino acid residues involved in Phe and Tyr effector binding sites. A. methanolica wild-type cells grown on glucose mineral medium normally possess a bifunctional CM/DAHP synthase protein complex (with DS1, a plant-type DAHP synthase). The CM activity of this protein complex is feedback-inhibited by Tyr and Phe, while DS1 activity is mainly inhibited by Trp. Isolation of pFPhe-resistant mutants yielded two feedback-inhibition-resistant CM mutants. These were characterized as regulatory mutants, derepressed in (a) synthesis of CM, now occurring as an abundant, feedback-inhibition-resistant, separate protein, and (b) synthesis of an alternative DAHP synthase (DS2, an E. coli-type DAHP synthase), only inhibited by Tyr and Trp. DS1 and DS2 thus are well integrated in A. methanolica primary metabolism: DS1 and CM form a protein complex, which stimulates CM activity and renders it sensitive to feedback inhibition by Phe and Tyr. Synthesis of CM and DS2 proteins appears to be controlled co-ordinately, sensitive to Phe-mediated feedback repression.