Endoluminal methods of treating gastroesophageal reflux disease.

Several endoluminal methods of treating gastroesophageal reflux disease (GERD) have either been approved, or are under investigation and development. This review outlines the two approved methods (Bard's endoluminal sewing machine and Curon's Stretta radiofrequency treatment), and describes the available data on new methods under investigation. The various methods can be divided into three broad categories: methods that create a controlled stricture, methods that bulk the gastroesophageal junction, and methods that attempt to create a fundoplication. The pros and cons of each method are discussed. Unlike medical treatment, these methods attack the reflux itself, not just the symptoms. This is a promising approach. However, the controlled stricture and bulking methods do not approach the success rate of a standard fundoplication.

Body fat distribution and obesity in pre- and postmenopausal breast cancer.

BACKGROUND: Excessive body weight is known to increase the risk of postmenopausal, but not premenopausal breast cancer. Some studies have suggested that being overweight is protective against premenopausal breast cancer, but the evidence is not compelling. Much less is known about the role of body fat distribution in either pre- or postmenopausal breast cancer. METHODS: Breast cancer risk was examined in relation to body weight, height, Quetelet index (kg/m2), and waist/hip ratio (WHR) in the New York University Women's Health Study, a prospective cohort study. Cases were 109 premenopausal and 150 postmenopausal women diagnosed with breast cancer between 1985 and 1994. Non-cases were 8,157 cohort members free of breast cancer. RESULTS: Among premenopausal women, there was an increasing risk of breast cancer with increasing WHR. The relative risk (RR) of breast cancer increased to 1.72 (95% confidence interval [CI]: 1.0-3.1) in the upper quartile of WHR. The association was limited to subjects who had elevated Quetelet index, but not among those with lower weight. Overall, Quetelet index itself was not related to breast cancer risk in the premenopausal group, but there was a protective association among those ranking below the median WHR. In postmenopausal women, the RR for breast cancer increased to 2.36 (95% CI: 1.4-3.9) in the upper quartile of Quetelet index, but there was no association with WHR. Height was not associated with breast cancer in this study. CONCLUSIONS: The study confirms that excessive body weight increases breast cancer risk in postmenopausal women. On the contrary, in premenopausal women, excessive body weight may be protective among women who have a lower-body type of fat accumulation (low WHR). An upper-body fat accumulation (high WHR) is a predictor of breast cancer risk in premenopausal women, and this effect is especially pronounced among subjects who are overweight.

Sex difference in the size of the neural song control regions in a dueting songbird with similar song repertoire size of males and females.

Previous studies have suggested a causal relation between sex differences in behavior such as singing and sex differences in the size of brain areas such as the forebrain song control areas of songbirds. In the present study we show that the size of the forebrain vocal control areas nucleus hyperstriatalis ventrale pars caudale (HVC) and nucleus robustus archistriatalis (RA) and its neuron numbers are about twice as large in males as in females of the African dueting bush shrike Laniarius funebris. However, song types are of similar complexity (number of elements per song type, physical properties of elements) in both sexes, and repertoire size does not differ between males and females. Furthermore, in captivity male and female shrikes are able to learn the same song types. This demonstrates for the shrike that sex differences in the size of vocal control areas and in its neuron numbers do not predict the type of sex-typical vocal behavior. This result is supported by a statistical comparison of the sex differences in HVC size, RA size, and song repertoire size of all songbird species studied to date. Sex differences in species in which only the males sing are indeed larger than in species in which the females also sing; in songbird species with singing females, however, the sex differences in HVC and RA volume appear to be independent of the vocal repertoire size of females. The songbird model therefore does not support the notion that sex differences in area size and neuron number explain sex differences in a behavior that occurs in both sexes. Furthermore, in the shrike, neuron soma size is similar in males and females in the song motonucleus hypoglossus pars tracheosyringealis (nXIIts) and in the premotor nucleus RA, but is sexually dimorphic in the higher vocal center HVC. Thus, male and female shrikes produce songs of similar complexity with different neuron phenotypes.

The estimated frequency of cosmetic breast augmentation among US women, 1963 through 1988.

Estimates ranging from 1 to 2 million have been used to describe the number of women in the United States who have had cosmetic breast implants. Original data from a historical cohort study of women with breast augmentation were combined with simulation techniques to compute new estimates grounded on a more objective set of information and assumptions than previous attempts. It was estimated that the number of women who had cosmetic augmentation mammoplasty between 1963 and 1988 was 894,206 (range = 437,602 to 2,035,783). The number of women ever treated with cosmetic augmentation mammoplasty may be substantially smaller than previously reported.

Sources of variability in waist and hip measurements in middle-aged women.

The reliability of single measurements of waist and hip circumference and the ratio of waist circumference to hip circumference (a widely used measure of body fat distribution) has not been fully examined. The authors analyzed measurements of waist and hip circumference, as well as self-reported weight and height, repeated 3-6 times between 1986 and 1991 among 1,851 participants in the New York University Women's Health Study. Quetelet index (weight (kg)/height (m)2) was positively correlated with waist circumference (r = 0.88), hip circumference (r = 0.89), and waist/hip ratio (r = 0.52). Mean weight was positively correlated with the within-subject variance of waist circumference (r = 0.27) and, to a lesser degree, with the within-subject variance of hip circumference (r = 0.08) and waist/hip ratio (r = 0.10). The within-subject variance of weight was positively correlated with the within-subject variance of waist (r = 0.30) and hip (r = 0.23) measurements, and less so with waist/hip ratio (r = 0.05). Intraclass correlations for waist, hip, and waist/hip ratio were 0.89, 0.81, and 0.74, respectively; adjustment for Quetelet index reduced the intraclass correlations for waist and hip measures by 33% and 48%, respectively. Such adjustment can provide a more realistic determination of the reliability associated with an exposure variable in the design and analysis of studies investigating the relation between body fat distribution and disease.

Antiphonal duetting and sex hormones in the tropical bush shrike Laniarius funebris (HARTLAUB).

We investigated changes in antiphonal duetting with phases of reproduction and circulating levels of luteinizing hormone, testosterone, and estradiol in slate-colored boubous (Laniarius funebris) breeding in aviaries. Frequency of overall male singing did not vary with reproductive phase while frequencies of female singing and female vocal responses to male song were reduced during incubation and feeding of nestlings. This resulted in significant changes in frequency of duetting. Males sang the sexual song type M1 more often during courtship and nest building than during the nestlings phase. Their territorial song types M2 and M4 did not vary with breeding phase. Females were less responsive to M1 during incubation and to M2 during the nest building and nestlings than during the courtship phase. Plasma levels of luteinizing hormone and testosterone increased in males from the prebreeding to the courtship phase. While testosterone decreased already during nest building and remained low during subsequent phases of reproduction, luteinizing hormone decreased during incubation and feeding of nestlings. Female luteinizing hormone levels were highest during nest building. Female estradiol levels decreased from nest building to incubation and increased again during subsequent nest building. Female testosterone levels were low but not basal and did not vary with phase. Neither the overall male and female singing frequencies nor the frequencies of male song types were correlated with hormonal state. However, female participation in territorial duets M4 correlated positively with their testosterone levels. It is suggested that in this monogamous, duetting species with prolonged pairbonds behavioral cues between the mates are more important than the hormonal state in control of male and female singing.

Endogenous hormones and breast cancer: a prospective cohort study.

A cohort study is under way in New York City to evaluate how levels of endogenous reproductive hormones influence the risk of breast cancer. The study, in which approximately 15,000 women are being recruited, utilizes a prospective design in which volunteers are asked to provide repeated specimens of serum during the period 1985-1992. A case-control study nested within the cohort is planned by which specimens from all cases arising in the population and from a randomly selected sample of time-matched controls will be analyzed and compared. As of December 31, 1989, 13,609 volunteers had donated blood specimens, about 50% of whom had already donated more than once. Of the 187 incident breast cancer cases who are expected to arise in the cohort before the end of 1992, 77 have been detected thus far.

Body conformation, diet, and risk of breast cancer in pet dogs: a case-control study.

Canine and human breast cancer share several important clinical and histologic features. A case-control study of nutritional factors and canine breast cancer was conducted at the Veterinary Hospital of the University of Pennsylvania in 1984-1987 by interviewing owners of 150 pet dogs diagnosed with breast cancer, owners of 147 cancer control dogs, and owners of 131 noncancer control dogs. The risk of breast cancer was significantly reduced in dogs spayed at or before 2.5 years of age. Neither a high-fat diet nor obesity 1 year before diagnosis increased the risk of breast cancer according to multiple logistic regression analysis. However, the risk of breast cancer among spayed dogs was significantly reduced in dogs that had been thin at 9-12 months of age (odds ratio (OR) = 0.04 (95% confidence interval (CI) 0.004-0.4) and OR = 0.04 (95% CI 0.004-0.5) for cases vs. cancer controls and cases vs. noncancer controls, respectively, after adjustment for age at spay). Among intact dogs, the risk associated with being thin at 9-12 months of age was reduced, but not significantly so (OR = 0.60 (95% CI 0.2-1.9) and OR = 0.51 (95% CI 0.2-1.4) for the two comparisons, respectively). Results of this study suggest that nutritional factors operating early in life may be of etiologic importance in canine breast cancer.

Histopathologic and dietary prognostic factors for canine mammary carcinoma.

Histologic and dietary prognostic factors for survival following naturally occurring breast cancer were studied for 145 pet dogs. Information was collected from the dog's owner and veterinarian regarding medical and reproductive history, nutritional status, treatment, tumor recurrence, and length of survival. The usual intake of all dog and table foods consumed 1 year prior to diagnosis was obtained using a validated quantitative food frequency questionnaire. A histologic malignancy score was derived based on 7 histopathologic criteria. The mean age of the dogs was 10.4 +/- 2.5 years; 37% had been ovariohysterectomized prior to diagnosis. Product-limit estimates of survival indicated that 6 factors, namely body conformation 1 year prior to diagnosis (p = 0.03), histologic tumor type (p = 0.004), histologic malignancy score (p = 0.02), histologic invasion (p = 0.002), tumor recurrence (p less than 0.0001), and completeness of surgery (p = 0.01) were of prognostic significance. In addition, when dogs were characterized by the percent of total calories they derived from fat and protein, the median survival time for dogs in the low fat group (less than 39%) with protein greater than 27%, 23-27%, and less than 23% was 3 years, 1.2 years, and 6 months, respectively (p = 0.008). For dogs in the high fat group (greater than or equal to 39%), there was no difference in survival for the different intake levels of dietary protein (p = 0.84). When these data were fitted to a proportional hazards model, recurrence, histologic score, tumor type, percent of calories derived from protein, fat group, and a protein-fat group interaction term were statistically significant. Predicted 1 year survival for dogs on a low fat diet with 15%, 25%, and 35% of total calories derived from protein was 17%, 69%, and 93%, respectively.

Prevalence of intestinal parasites in Latino residents of Chicago.

In 1970, 250,000 Spanish-speaking persons resided in Chicago, 80,000 of whom were Puerto Rican. Because migration to Chicago is constantly occurring from areas where intestinal parasites are endemic, a survey was conducted in a predominantly Puerto Rican neighborhood to determine the prevalence of these parasites and to provide impetus for further case finding and treatment programs. The survey was part of an epidemiologic and cutreach workers going door-to-door obtained histories, hematocrits, and single stool specimens from 358 individuals. An overall intestinal parasite prevalence rate of 18.6% (67 persons) was found. Specific rates were Trichuris trichiura 13.9% (50 cases), hookworm 6.6% (24 cases), Giardia lamblia (3.9% (14 cases), and Strongyloides stercoralis 1.7% (6 cases). There were no cases of Ascaris lumbricoides or ENTAMOEBA HISTOLYTICA, Although several nonpathogenic protozoa were found. The most affected age groups were 15--24 years followed by 5--14. Two of the Giardia cases were individuals never out of the continental United States. An incidental finding was a high rate of low hematocrit readings not correlated with the parasite findings.