Severity of bulimic symptoms is the best predictor of interference on an emotional Stroop paradigm.

OBJECTIVE: The goal of the current study was to further investigate whether an emotional Stroop effect exists among patients with bulimia nervosa. METHOD: Performances of 30 female controls, 30 females with subclinical eating disordered symptoms, and 30 females diagnosed with bulimia nervosa were compared on an emotional Stroop color naming task using stimuli separated into three areas of concern (eating, weight, and shape words). RESULTS: Results indicated that overall the three groups differed significantly on the emotional Stroop task, with the interference latency for disorder salient words progressively increasing as the severity of bulimic symptoms increased. Severity of bulimic symptoms was the best predictor of interference on the emotional Stroop paradigm. DISCUSSION: Results provide further evidence that interference on the emotional Stroop is uniquely related to the symptoms of bulimia nervosa and bear credence to the possibility of its use as an additional tool in the diagnosis of bulimia nervosa.

Uterine effects of tamoxifen: a prospective study.

The purpose of the study was to evaluate tamoxifen-associated changes in the vagina and uterus in postmenopausal breast cancer patients. Between June 1994 and December 1998, 45 patients enrolled in a prospective study before commencing tamoxifen therapy. Patients with endometrial thickness >5 mm or neoplasia were excluded. Transvaginal ultrasonography, vaginal maturation indexes (VMI), and endometrial biopsy were performed at baseline and repeated at 6 months (n= 42), 1 year (n= 39), 2 years (n= 32), 3 years (n= 26), 4 years (n= 19), and 5 years (n= 15). For the 39 patients followed for 1 year, VMI (% parabasal/intermediate/superficial) was 21/71/8 at baseline compared with 1/90/9 at 1 year (P value = 0.0008/0.001/0.78). At baseline, mean endometrial thickness and uterine volume were 2.6 mm and 64 cm(3), respectively, compared with 5.8 mm and 84 cm(3) at 1 year (P= 0.0002, 0.002). At baseline, 80% of patients had atrophic endometrium and 9% proliferative endometrium compared with 61% and 26% at 1 year, respectively (P= 0.04). No cases of endometrial hyperplasia or adenocarcinoma were detected. Findings observed at 6 months persisted through 5 years of follow-up. Tamoxifen exerts a weak estrogenic effect on the vagina and uterus in highly prescreened postmenopausal women without preexisting endometrial pathology.

Clinical and cost effectiveness of a new hepatocellular MRI contrast agent, mangafodipir trisodium, in the preoperative assessment of liver resectability.

BACKGROUND: Improved preoperative assessment of focal liver disease and tumors could have a potentially significant impact on their treatment. Mangafodipir trisodium (Teslascan; Nycomed Amersham Imaging, Little Chalfont, UK) is a new hepatocellular contrast agent for use with state-of-the-art MR imaging that, in early reports, is accurate in detection and characterization of liver lesions. METHODS: Records and diagnostic images of all patients undergoing enhanced Teslascan MRI (T-MRI) at our institution were reviewed. We assessed the relative sensitivities of contrast-enhanced CT scan (CECT) and T-MRI in detecting lesions, as well as the impact of T-MRI in the decision to operate or not on patients. In those patients taken to surgery, the correlation between T-MRI and intraoperative palpation and intraoperative ultrasound (IOUS) was determined. RESULTS: Fifty-four patients were noted on CECT to have focal liver lesions and subsequently underwent imaging with T-MRI. The T-MRI correlated with CT findings in 22 patients (41%), upstaged the liver disease in 26, and demonstrated fewer lesions in 6. Only 43 patients were considered operative candidates and T-MRI influenced the operative decision in 32 patients (74%), dissuading operative intervention in 14. In the 25 patients without clear preoperative evidence of unresectability who were taken to the operating room, T-MRI correlated with findings of intraoperative palpation in 19 (76%). In the 20 patients who underwent IOUS, T-MRI correlated with IOUS in 14 patients (70%). IOUS detected an additional nine lesions, all of which were <1 cm. Seventeen patients underwent resection and/or ablation of their liver lesions. Compared with pathology, sensitivities of CECT, T-MRI, and intraoperative evaluation were 61%, 83%, and 93%, respectively. T-MRI failed to predict hepatic-specific unresectability in only one of eight patients, the other seven having extrahepatic disease. CONCLUSIONS: These findings suggest that T-MRI is more sensitive than CECT in the preoperative predicting of the resectability of hepatic lesions. Despite T-MRI accurately correlating with intraoperative surgical findings, IOUS should be performed on all patients prior to a final decision to resect or ablate a focal liver lesion.

Glycerol kinase deficiency: evidence for complexity in a single gene disorder.

Glycerol kinase deficiency (GKD) occurs as part of an Xp21 contiguous gene syndrome or as isolated GKD. The isolated form can be either symptomatic with episodic metabolic and central nervous system (CNS) decompensation or asymptomatic with hyperglycerolemia and glyceroluria only. To better understand the pathogenesis of isolated GKD, we sought individuals with point mutations in the GK coding region and measured their GK enzyme activities. We identified six individuals with missense mutations: four (N288D, A305V, M428T, and Q438R) among males who were asymptomatic and two (D198G, R405Q) in individuals who were symptomatic. GK activity measured in lymphoblastoid cell lines or fibroblasts was similar for the symptomatic and the asymptomatic individuals. Mapping of the individuals' missense mutations to the three-dimensional structure of Escherichia coli GK revealed that the symptomatic individuals' mutations are in the same region as a subset of the mutations among the asymptomatic individuals, adjacent to the active-site cleft. We conclude that, like many other disorders, GK genotype does not predict GKD phenotype. We hypothesize that the phenotype of an individual with GKD is a complex trait influenced by additional, independently inherited genes.

Molecular phylogeny of the genus Kalanchoe (Crassulaceae) inferred from nucleotide sequences of the ITS-1 and ITS-2 regions.

The study presents an analysis of genotypic diversity in the genus Kalanchoe (Crassulaceae) on the level of Internal Transcribed Spacer (ITS) sequences and the attempt to correlate this diversity with previous findings on ecophysiological behavior, habitat preference, infrageneric taxonomic position of the species and DNA polymorphism derived from RAPD-PCR data. The Kalanchoe species are mainly abundant in Madagascar and eastern continental Africa and perform in situ diverse modes of crassulacean acid metabolism (CAM), an ecophysiologically relevant adaptation of photosynthesis. Total DNA was extracted from 68 Kalanchoe species and varieties. The ITS-1 and ITS-2 regions of the nuclear RNA genes were amplified by polymerase chain reaction, cloned and sequenced. The alignments of the sequences were evaluated by distance (neighbor joining) and character state (maximum parsimony) methods. The main topologies of the obtained ITS phylogenetic trees were quite similar irrespective of the mode of evaluation and show: (A) within the Crassulaceae the genus Kalanchoe forms a monophyletic clade; and (B) within the genus the species form three main clusters which coincide well with the previously reported three infrageneric sections of the species distinguishable by classical taxonomic criteria, the mode of in situ CAM performance, and DNA fragment pattern obtained by RAPD-PCR analyses. Moreover, the ITS phylogenetic trees show that all African Kalanchoe species form a distinct group within the most derived of the three main clusters. This is consistent with the view that the center of phylogenetic radiation of the genus is located in Madagascar from where the species have spread into the continental Africa.

A survey of the influence of patients' choice on the increase in the caesarean section rate.

The caesarean section rate in the Royal Gwent Hospital has, as in the rest of the UK, risen significantly over the last 10 years. A commonly proposed reason for this increase is that women themselves are now more likely to request an elective caesarean section, when there is little or no medical indication. The aim of this survey, carried out prospectively, was to find out whether patients' requests for caesarean section are contributing significantly to the rise in the section rate, by attempting to actually quantify the influence of patients' choice on the decision to perform a caesarean section. The results showed that it is possible to quantify this influence, and that maternal request does play a major role in the decision-making process.

High levels of Lp(a) with a small apo(a) isoform are associated with coronary artery disease in African American and white men.

Elevated levels of lipoprotein(a) [Lp(a)] and the presence of small isoforms of apolipoprotein(a) [apo(a)] have been associated with coronary artery disease (CAD) in whites but not in African Americans. Because of marked race/ethnicity differences in the distribution of Lp(a) levels across apo(a) sizes, we tested the hypothesis that apo(a) isoform size determines the association between Lp(a) and CAD. We related Lp(a) levels, apo(a) isoforms, and the levels of Lp(a) associated with different apo(a) isoforms to the presence of CAD (>/=50% stenosis) in 576 white and African American men and women. Only in white men were Lp(a) levels significantly higher among patients with CAD than in those without CAD (28.4 versus 16.5 mg/dL, respectively; P:=0.004), and only in this group was the presence of small apo(a) isoforms (<22 kringle 4 repeats) associated with CAD (P:=0.043). Elevated Lp(a) levels (>/=30 mg/dL) were found in 26% of whites and 68% of African Americans, and of those, 80% of whites but only 26% of African Americans had a small apo(a) isoform. Elevated Lp(a) levels with small apo(a) isoforms were significantly associated with CAD (P:<0.01) in African American and white men but not in women. This association remained significant after adjusting for age, diabetes mellitus, smoking, hypertension, HDL cholesterol, LDL cholesterol, and triglycerides. We conclude that elevated levels of Lp(a) with small apo(a) isoforms independently predict risk for CAD in African American and white men. Our study, by determining the predictive power of Lp(a) levels combined with apo(a) isoform size, provides an explanation for the apparent lack of association of either measure alone with CAD in African Americans. Furthermore, our results suggest that small apo(a) size confers atherogenicity to Lp(a).

Race-related differences among patients with left ventricular dysfunction: observations from a biracial angiographic cohort. Harlem-Bassett LP(A) Investigators.

BACKGROUND: This study was designed to describe race-related differences in left ventricular function among a consecutive series of patients undergoing cardiac catheterization and to identify racial differences in coexistent medical and social conditions that are associated with the development of heart failure (HF). METHODS AND RESULTS: This was a prospective cohort study conducted at 2 university-affiliated teaching hospitals. We used the database of the Harlem-Bassett Lp(a) Study. We included all black (N = 143) or white (N = 313) patients from the main study database for whom complete survey, laboratory, coronary angiographic, and ventriculographic data were available. "Left ventricular dysfunction" was arbitrarily defined as an ejection fraction < or =0.40 or prior pharmacologic treatment for HF. We found that blacks were younger, had a higher proportion of women, and had fewer years of formal education than their white counterparts. Coronary artery disease was less common among blacks, although this group had a higher prevalence of hypertension, diabetes, cigarette smoking, illicit drug use, and alcohol consumption. Black patients had a higher prevalence of previous treatment for HF, larger left ventricular volumes, and lower ejection fractions than white patients. Blacks with left ventricular dysfunction were more likely to have had a previous myocardial infarction or a history of hypertension compared with those without left ventricular dysfunction. CONCLUSIONS: Regarding left ventricular dysfunction and HF, we conclude that blacks seem to have a much higher burden of disease than whites. Our observations support prior evidence that hypertension is linked to race-related differences in the epidemiology of HF. The interaction between race and access to quality care for HF remains an important area for future investigation.

Analysis of the 1998 outbreak of leptospirosis in Missouri in humans exposed to infected swine.

OBJECTIVE: To determine the extent of leptospirosis in persons exposed to infected swine, confirm the source of disease, define risk factors for infection, and identify means for preventing additional infections during an outbreak in Missouri in 1998. DESIGN: Cross-sectional study. SAMPLE POPULATION: 240 people and 1,700 pigs. PROCEDURE: An epidemiologic investigation was conducted of people exposed to infected pigs from the University of Missouri-Columbia swine herd. The investigation included review of health of the pigs, a cross-sectional study of the people handling the pigs, serologic testing of human and porcine sera, and risk-factor analysis for leptospirosis within the human population. RESULTS: Serologic testing of samples collected at the time of the investigation indicated that 59% of the pigs had titers to leptospires, denoting exposure. Of the 240 people in the exposed study population, 163 (68%) were interviewed, and of these, 110 (67%) submitted a blood sample. Nine (8%) cases of leptospirosis were confirmed by serologic testing. Risk factors associated with leptospirosis included smoking (odds ratio [OR], 14.4; 95% confidence interval [CI], 1.39 to 137.74) and drinking beverages (OR, 5.1; 95% CI, 1.04 to 24.30) while working with infected pigs. Washing hands after work was protective (OR, 0.2; 95% CI, 0.03 to 0.81). CONCLUSIONS AND CLINICAL RELEVANCE: Leptospirosis is a risk for swine producers and slaughterhouse workers, and may be prevented through appropriate hygiene, sanitation, and animal husbandry. It is essential to educate people working with animals or animal tissues about measures for reducing the risk of exposure to zoonotic pathogens.

[Reference ranges of antioxidant parameters in whole blood (erythrocytes) in a Thüringen region]. / Referenzbereiche antioxidativ wirkender Parameter im Vollblut (Erythrozyten) einer Thüringer Region.

BACKGROUND: The oxidant stress is characterized by measurement of the activities of glutathione peroxidase, superoxiddismutase and also by concentrations of glutathione and selenium in erythrocytes. A standardization of the methods of determination is very important. MATERIAL AND METHODS: In erythrocytes of blood donors (n = 101) the parameters glutathione peroxidase, glutathione, superoxiddismutase and selenium were determined. RESULTS: The following results of the antioxidant parameters in erythrocytes of blood donors were found: Selenium 67.1 +/- 20.1 nmol/mmol Hb, glutathione peroxidase 842 +/- 290 U/mmol Hb, glutathione 108 +/- 48 mumol/mmol Hb, superoxiddismutase 15.8 +/- 6.4 U/mumol Hb. CONCLUSION: Selenium, glutathione peroxidase, glutathione and superoxiddismutase in erythrocytes of blood donors are normally distributed. There are no significant differences between men and women. The use of "own reference values" is necessary because no standardization of the methods of determination exists.

Short- and long-term effects of training phonological awareness in kindergarten: evidence from two German studies.

Two training studies replicated and extended a Scandinavian study by Lundberg, Frost, and Petersen (1988). In Study 1, a 6-month metalinguistic training program was given to kindergartners (mean age: 5 years 7 months) who were later compared to a control group in the regular kindergarten program. Tests of phonological awareness and other metalinguistic and cognitive variables were given before and after training; a metalinguistic transfer test was given after training. Reading and spelling skills were assessed at the end of Grades 1 and 2, respectively. The training program was improved and monitored more closely in Study 2. Both studies revealed short- and long-term effects, consistent with Lundberg et al. (1988) and extending findings from Anglo-American and Scandinavian populations to German children.

[The dilemma of effectiveness and economic value of alternative medicine]. / Das Dilemma von Wirksamkeit und Wirtschaftlichkeit bei alternativen Heilmethoden.

Medical practice is today, and has always been, subject to a professional ethos that excludes unnecessary and dishonest methods. There is some concern about soundness and affordability of our health service if one sees that despite the financial worries that beset our health services, more and more alternative treatments are being proposed and used which are not equal to their money's worth. Political and legal decisions, as well as the activities of alternative healers, illustrate the onslaught on the supremacy of scientific teaching. These developments must be opposed vigorously for sake of protecting our patients.

[Evaluation of the meat quality of game]. / Zur Beurteilung der Fleischqualität bei Schalenwild.

The carcasses of 140 roe deer, 129 wild boars, 81 red deer and 55 fallow deer were examined to determine meat quality with respect to the influence of typical hunting situations. After hunting, many carcasses had not been cooled, which significantly influenced meat-quality parameters. The pH-value, detected electrochemically, gave the most reliable results out of all the meat-quality parameters investigated. Determination of the pH-value with regard to the pH indexes ascertained for different points of measurement and types of game is helpful in properly judging the substantial quality of venison. Determination of electrical conductivity and water-holding capacity (Q) can be helpful in judging meat quality. The value of residual-blood content in judging substantial venison quality is, however, doubtful. The measurement of rapid glycolysis and the evaluation of rigor mortis are not appropriate for determining the substantial quality of venison.

[Comparative investigations of mycotoxological status of alternatively and conventionally grown crops]. / Vergleichende Untersuchungen zum mykotoxikologischen Status von ökologisch und konventionell angebautem Getreide.

100 samples of rye and 101 samples of wheat coming out of both conventional and alternative or ecological production were investigated for contamination with mycotoxins with interest for our degree of latitude. Deoxynivalenol (DON) was found with thin-layer-chromatography in 131 of 201 samples altogether. A top level of 1250 micrograms DON kg-1 in rye of alternative offspring was detected. The average burden in contaminated rye coming from ecological production was 427 micrograms kg-1 and a mean level of 160 micrograms kg-1 resulting in rye out of conventional growth conditions. In wheat, conventionally grown yield showed slightly lower contamination (mean levels of 420 micrograms DON kg-1 towards 486 micrograms kg-1). The toxins 3-acetyl-deoxynivalenol, nivalenol and fusarenone X were detected in some samples by thin-layer-chromatography. This results could not be confirmed by gas chromatography -mass spectrometry. Zearalenone was found in 40 out of the number of 201 samples of grain by HPLC with fluorescence detection. An average of 6 micrograms and 24 micrograms zearalenone kg-1 in conventionally and alternatively grown wheat and 4 micrograms and 51 micrograms zearalenone kg-1 in conventionally and alternatively produced rye was detected. The highest finding of zearalenone was 199 micrograms kg-1 in alternatively grown rye. Skin toxicity testing did not show any reference of contamination with type-A-trichothecenes. No correlation between contamination of zearalenone or deoxynivalenol and thousand-kernel-weight was detected.