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To preliminarily examine throughout pregnancy and 12 months postpartum: 1) the critical timings of abnormal gestational weight gain (GWG) among quitters and non-quitters; 2) the consequences of abnormal GWG on weight retention during postpartum; 3) the potential difference in GWG by timing of quitting (early vs. late).We included 59 pregnant smokers (49 quitters and 10 non-quitters) from two clinical pilot studies. Smoking status and weight were repeatedly measured throughout pregnancy and postpartum. Weight trajectories were analyzed using mixed models with smoking cessation status, pregnancy week or postpartum month, their interaction term, and potential confounders.At enrollment, mothers had a mean BMI of 28.7 (SD, 7.2) and mean age of 30.1 years (SD, 5.8). Both groups had a linear increase in GWG, but quitters had a much higher rate of GWG (0.87 vs. 0.22 pounds/week) than non-quitters throughout pregnancy. Before delivery, 63.3% of quitters and 20.0% of non-quitters had excessive total GWG, while 12.2% of quitters and 60.0% of non-quitters had inadequate total GWG (p-value=0.004). Early quitters (21 weeks) had a higher risk of excessive GWG (85.0%) than late quitters (≥21 weeks, 36.4%) (p-value=0.026). After delivery, quitters' weight remained stable following a rapid weight loss, whereas non-quitters' weight increased continuously.Non-quitters have a high risk of inadequate GWG, while quitters, especially early quitters, have a high risk of excessive GWG. The group difference in weight trajectories lasted from conception to postpartum.

Unconventional oil and gas development (UOGD) releases chemicals that have been linked to cancer and childhood leukemia. Studies of UOGD exposure and childhood leukemia are extremely limited.The objective of this study was to evaluate potential associations between residential proximity to UOGD and risk of acute lymphoblastic leukemia (ALL), the most common form of childhood leukemia, in a large regional sample using UOGD-specific metrics, including a novel metric to represent the water pathway.We conducted a registry-based case-control study of 405 children ages 2-7 y diagnosed with ALL in Pennsylvania between 2009-2017, and 2,080 controls matched on birth year. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between residential proximity to UOGD (including a new water pathway-specific proximity metric) and ALL in two exposure windows: a primary window (3 months preconception to 1 y prior to diagnosis/reference date) and a perinatal window (preconception to birth).Children with at least one UOG well withinOur study including a novel UOGD metric found UOGD to be a risk factor for childhood ALL. This work adds to mounting evidence of UOGD's impacts on children's health, providing additional support for limiting UOGD near residences. https://doi.org/10.1289/EHP11092.

When a patient with acute psychosis refuses antipsychotic medication despite a clear need for treatment, involuntary medication is often considered. When the patient is both pregnant and acutely unwell, an additional layer of analysis enters the picture. This analysis then also includes the health of the mother and fetus, rights of the mother and fetus, and whose rights take precedence when choosing treatment options in event of a conflict. Antipsychotic agents are frequently the medications prescribed as involuntary treatment. Typical and atypical antipsychotic agents are often used in both emergent and nonemergent situations during pregnancy. Despite a lack of randomized, double-blind, controlled, prospective studies in pregnancy, available data regarding the safety of antipsychotic agents in pregnancy are relatively reassuring. At the same time, the risks of untreated psychosis, for both the mother and the fetus, are not negligible. Such cases merit ethics-related and legal analyses. Forensic psychiatrists involved in such cases need to consider the patient's capacity to make medical decisions and be able to discuss the potential risks, benefits, and alternatives with patients and in court, as part of initiation of involuntary treatment.

Background Laparoscopic lavage was proposed in the 1990s to treat purulent peritonitis in patients with perforated acute diverticulitis. Prospective randomized trials had mixed results. The aim of this study was to determine the success rate of laparoscopic lavage in sepsis control and to identify a group of patients that could potentially benefit from this treatment. Methods This retrospective multicentre international study included consecutive patients from 24 centres who underwent laparoscopic lavage from 2005 to 2015. Results A total of 404 patients were included, 231 of whom had Hinchey III acute diverticulitis. Sepsis control was achieved in 172 patients (74·5 per cent), and was associated with lower Mannheim Peritonitis Index score and ASA grade, no evidence of free perforation, absence of extensive adhesiolysis and previous episodes of diverticulitis. The operation was immediately converted to open surgery in 19 patients. Among 212 patients who underwent laparoscopic lavage, the morbidity rate was 33·0 per cent; the reoperation rate was 13·7 per cent and the 30-day mortality rate 1·9 per cent. Twenty-one patients required readmission for early complications, of whom 11 underwent further surgery and one died. Of the 172 patients discharged uneventfully after laparoscopic lavage, a recurrent episode of acute diverticulitis was registered in 46 (26·7 per cent), at a mean of 11 (range 2–108) months. Relapse was associated with younger age, female sex and previous episodes of acute diverticulitis. Conclusion Laparoscopic lavage showed a high rate of successful sepsis control in selected patients with perforated Hinchey III acute diverticulitis affected by peritonitis, with low rates of operative mortality, reoperation and stoma formation.

We extend investigations of the impact of the content of video contact with an individual with schizophrenia on stigma reduction. We examine whether differential impacts persist over a 2-week period and the extent to which they are mediated by perceived similarity and feelings of empathy and/or sympathy. We used a randomized control trial wherein participants were exposed to a video in which an individual described his recovery from schizophrenia, or the same person described acute symptoms of schizophrenia, or a no-video control condition. Outcomes included impressions of and preferred social distance to the person in the video and people in general with schizophrenia and well as perceptions of similarity and feelings of sympathy and empathy. We also measured an overt behaviour, seating distance, at 2-week follow-up. The recovery-focused material was generally more effective in improving impressions and reducing preferred level of social distance. Although the symptom-focused video resulted in great sympathy for the person, this did not translate into positive impressions or reduced social distance. Mediational analyses yielded findings consistent with the benefits of the recovery video being mediated by increased perceptions of similarity and lower feelings of sympathy. Exposure to the recovery-focused video resulted in less anxiety in anticipation of meeting the person in the video relative to the control condition. Video contact emphasizing potential for recovery from schizophrenia was more effective in reducing stigmatizing responses than contact highlighting acute symptoms. Increased sympathy does not necessarily translate into reductions in stigma.

The ideal treatment of perforated diverticulitis and the indications for elective colon resection remain controversial. Considering the significant morbidity and mortality rates related to traditional resection, efforts have been made to reduce the invasiveness of surgery in recent decades. Laparoscopic peritoneal lavage has emerged as an effective alternative option. We retrospectively investigated the effectiveness of laparoscopic peritoneal lavage for perforated diverticulitis and the possibility that it could be a definitive treatment.We included patients treated with laparoscopic peritoneal lavage for perforated diverticulitis. The inclusion criteria were all emergency patients with generalized peritonitis due to Hinchey III perforated diverticulitis and some cases of Hinchey II and IV.Sixty-three patients were treated with laparoscopic peritoneal lavage. Six patients (9.5 %) had Hinchey II diverticulitis; 54 patients (85.7 %) had Hinchey III; and three patients (4.8 %) had Hinchey IV. The mean operative time was 87.3 min (±25.4 min), and the overall morbidity rate was 14.3 %. One patient died because of pulmonary embolism, and there were six early reinterventions because of treatment failure. Delayed colon resection was performed in four of the remaining 57 patients (7 %) because of recurrent diverticulitis. In the other 53 patients (93 %), we saw no recurrence of diverticulitis and no intervention was performed after a median follow-up period of 54 months (interquartile range 27-98 months).Laparoscopic peritoneal lavage for perforated diverticulitis can be considered a safe and effective alternative to traditional surgical resection, and using this approach, most elective colon resection might be avoided.

There is evidence that personal value priorities may influence prejudicial behaviors. In particular, it has been hypothesized that those who place a high priority on values such as equality, benevolence and social justice may be less likely to express any prejudicial personal attitudes in behavior. In the present study, we tested this hypothesis in the context of physical distance with reference to a person with schizophrenia. Self-transcendent value priorities and attitudes toward a young woman described as having schizophrenia were assessed in 95 university students. They were then led to anticipate meeting the person and the distance they sat from the expected location of the ill person was assessed.Women sat closer to the anticipated seat of the person with schizophrenia. In addition, there was a significant interaction between priority placed on self-transcendent values and attitude toward the person in predicting seating distance. There was a significant relationship between favorability of attitudes and sitting closer for those who were low in self-transcendent values, but attitudes did not predict physical proximity for those with high self-transcendent values.The impact of attitudes toward an individual with schizophrenia and subtle aspects of behavior such as physical proximity appear to be moderated by self-transcendent personal values. The role of implicit in comparison to explicit attitudes in explaining these results is worthy for further investigation.

Ventilatory efficiency is commonly defined as the level of ventilation V(E) at a given carbon dioxide output (V(CO(2) )). The slope of the V(E) versus V(CO(2) ) relationship and the lowest V(E)/V(CO(2) ) are two ventilatory efficiency indices that can be measured during cardiopulmonary exercise testing (CPET). A possible CPET mode dependency for these indices was evaluated in healthy men and women. Also evaluated was the relationship between these two indices as, in theory, V(E)/V(CO(2) ) falls hyperbolically towards an asymptote that numerically equals the V(E) versus V(CO(2) ) slope at exercise levels below the ones that cause respiratory compensation for metabolic acidosis. Twenty-eight healthy subjects (14 men) underwent treadmill and cycle ergometer CPET on different days. Ventilation and the gas fractions for oxygen and CO(2) were measured with a vacumed metabolic cart. In men, paired t-test analysis failed to find a mode difference for either ventilatory efficiency index but the opposite was true in the women as each woman had higher values for both indices on the treadmill. For men, the lowest V(E)/V(CO(2) ) was larger than the V(E) versus V(CO(2) ) slope by 1.3 on the treadmill and 0.8 on the cycle ergometer. The corresponding values for women were 1.7 and 1.4. We conclude that in healthy subjects, women, but not men, demonstrate a mode dependency for the two ventilatory efficiency indices investigated in this study. Furthermore, our results are consistent with the theoretical expectation that the lowest V(E)/V(CO(2) ) has a numerical value just above the asymptote of the V(E)/V(CO(2) ) versus V(CO(2) ) relationship.

Indices of ventilatory efficiency have proven useful in assessing patients with heart and lung disease. One of these indices is the slope of the ventilation (V(E)) versus carbon dioxide output (VCO(2)) relationship during cardiopulmonary exercise testing (CPET) for work rates where the relationship is linear. However, this relationship is defined not only by the slope but also by the y-intercept. To examine whether this relationship is dependent on the speed of the CPET protocol, 30 healthy subjects (16 males) were administered a rapid CPET with 1-min increment duration (1-min CPET) to the limit of tolerance and a slow CPET with 4-min increment duration (4-min CPET) to the lactate threshold. Ventilation and the gas fractions for oxygen and CO(2) were measured with a Vacumed metabolic cart. The average increment size of both protocols for both sexes was not significantly different (P>0.05). For the males, the mean (SD) slope for the 1- and 4-min CPET was 20.12 (2.61) and 20.37 (2.41), respectively. The corresponding values for the y-intercept were 4..89 (2.08) and 5..10 (2.00) l min(-1). For the females, the mean (SD) slope for the 1- and 4-min CPET was 23.90 (2.38) and 24.16 (2.55), respectively. The corresponding values for the y-intercept were 3.93 (0.39) and 3.77 (0.71) l min(-1). Paired t-test analysis demonstrated for both sexes that the slopes and y-intercepts were not different for the two protocols (P>0.05). The results of this study demonstrate that the V(E) versus VCO(2) relationship is not dependent on the speed of the CPET protocol.

The stroke volume (SV) during exercise is an important index of the heart's functional capacity. A new method has been developed for the non-invasive estimation of exercise SV (SVex). It requires the determination of the slope for the oxygen uptake versus heart rate relationship in the steady state of graded exercise testing (GXT). The product of the slope and a constant (reciprocal of an assumed value of the arterial oxygen content) equals an estimated value for SVex. It was validated in a previous study using invasive measurements while subjects were performing steady-state GXT. However, currently the most commonly used GXT protocols are non-steady state, e.g. protocols with 1-min increment durations. We tested the hypothesis that SVex is the same for steady-state and non-steady-state GXT. A total of 30 subjects (15 males and 15 females) served as subjects for the study. Each subject performed two GXTs on different days with different increment durations - 1 and 4 min. Ventilation and gas exchange were measured with the Vacumed metabolic cart. For the male subjects, the mean (SD) SVex values for the 1- and 4-min GXTs were 155.4 (39.5) and 134.6 (27.5) ml, respectively. The corresponding values for the female subjects were 151.6 (37.6) and 134.3 (36.4) ml. Paired t-test analysis demonstrated that for both genders the mean SVex for the 1-min GXT was significantly larger than the 4-min GXT mean value (P

To increase rates of employment and improve overall rehabilitation in methadone maintenance treatment, three prevocational trainings, Vocational Problem Solving, Job Seekers Workshop, and the two combined, were evaluated as adjunctive services. Between March 1995 and April 1998, subjects in treatment were interviewed at baseline, randomly assigned to one of the trainings, and followed up at 6 and 12 months postbaseline. None of the three models produced significantly greater employment or better overall rehabilitation. Experience from the study suggests that closer integration of prevocational training with treatment, individualizing efforts to meet training needs, and providing support during job-finding and early job-holding might improve program effectiveness.

There is less research about homicidal women than about their male counterparts. Women are often considered the gentler sex, and their risk of perpetrating violent acts is underestimated. In attempts to understand violence by women with mental illness, female homicide offenders found not guilty by reason of insanity (NGRI) are an important subpopulation. Understanding common factors in this subpopulation (such as psychosis with religious delusions) may help in preventing severe violence perpetrated by women with mental illness. However, as with other crimes, those with mental illness who commit homicide may often have rational, nonpsychotic motives (such as anger, jealousy, self-defense, money, or criminal intent) and would not be captured in a study of those found NGRI. Further, caution must be used when studying an NGRI population, as there are potential gender biases in findings of insanity.

Objectives To review the normal and pathological development of the posterior membranous area (PMA) in the fetal brain, to define sonographic criteria with which to diagnose a Blake's pouch cyst (BPC) in the fetus and to review the ultrasound features, associations and outcome of 19 cases of BPC seen at our center over the last 5 years. Methods We conducted a MEDLINE search using the terms ‘Blake's pouch’, with or without ‘fourth ventricle’ or ‘4th ventricle’, with or without ‘roof’ and identified articles describing normal and/or abnormal development of the PMA, whether or not they were cited in the limited clinical literature on BPC. A description of the normal and abnormal development of BPC was derived by collating these articles. The clinical retrospective study included 19 cases of posterior fossa anomalies with a final diagnosis of BPC seen at our institution. The following variables were assessed: referral indication, gestational age at diagnosis, ultrasound and magnetic resonance imaging (MRI) findings, associated anomalies, natural history and pregnancy and neonatal outcome. A transvaginal three-dimensional (3D) ultrasound examination was performed in all cases and 15 cases underwent MRI. To confirm the diagnosis, postnatal MRI, transfontanellar ultrasound or autopsy were available in all cases. Results Among the 19 cases reviewed, referral indications were: suspicion of vermian abnormality in 11 (58%) cases and other non-central nervous system anomaly in eight (42%) cases. Sonographically, all cases showed the following three signs: 1) normal anatomy and size of the vermis; 2) mild/moderate anti-clockwise rotation of the vermis; 3) normal size of the cisterna magna. On 3D ultrasound, the upper wall of the cyst was clearly visible in 11/19 cases, with choroid plexuses on the superolateral margin of the cyst roof. On follow-up, the BPC had disappeared by 24–26 gestational weeks in six of the 11 cases which did not undergo termination of pregnancy (TOP), and remained unaltered until birth in the other five cases. There were associated anomalies in eight (42%) cases, in five of which this consisted of or included congenital heart disease. Karyotype was available in 14 cases, two of which were abnormal (both trisomy 21). Regarding pregnancy outcome, there were eight (42%) TOPs, two (10%) neonatal deaths and nine (48%) survivors. One neonate, in whom the BPC had disappeared by the time of birth, had obstructive hydrocephaly confirmed. Another neonate was diagnosed with Down syndrome after birth. Excluding the Down syndrome baby, neurodevelopmental outcome was normal at the time of writing in all eight cases. Conclusions Based on our analysis of ultrasound features, we propose that for BPC to be diagnosed in a fetus the following three criteria should be fulfilled: 1) normal anatomy and size of the vermis; 2) mild/moderate anti-clockwise rotation of the vermis; 3) normal size of the cisterna magna. Furthermore, we found that BPC can undergo delayed fenestration at 24–26 weeks in more than 50% of cases. Finally, it seems that BPC shows a risk of association with extracardiac anomalies (heart defects in particular) and, to a lesser extent, trisomy 21. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

It has been suggested that the study of the stigma of mental illness should include more behavioral measures and further investigation of the possible importance of implicit evaluations in predicting responses to those with such illness. In the current paper, we report a study testing the relationship of implicit and explicit evaluations to physical proximity and cortisol levels in anticipation of meeting someone with schizophrenia. The results showed that both explicit evaluations and cortisol levels independently predicted physical proximity. Implicit evaluations were not related to either physical proximity or cortisol levels. The findings suggest that there are aspects of emotional response to those with mental illness that are not reflected in explicit measures of evaluation and that these, as well as explicit responses, can contribute to the prediction of behavior.

Background: Social psychological research suggests that prediction of behavioural intentions towards those with mental illness could be increased by assessing attitudes towards specific actions or behaviours and by including a measure of perceived normative expectations by others concerning such behaviours. Aims: To investigate whether attitudes towards specific behaviours and perceived normative expectations improve prediction of behavioural intentions towards a person with mental illness. Methods: Two studies were carried out; one with university undergraduates and one with community service club members. Each included assessments of attitudes towards a person described as having a mental illness; attitudes towards specific behaviours reflecting social distance; perceived descriptive and injunctive norms with reference to those behaviours; and behavioural intentions. Results: Attitude towards the specifi c behaviour frequently showed a higher correlation with behavioural intentions than did attitude towards the person. Inclusion of perceived norms also improved prediction of behavioural intention. Conclusions: The prediction of behavioural intentions towards those with mental illness may be improved by increasing the specificity of the attitude measures to the behavioural intentions being predicted and including measures of perceived norms. Furthermore, the effectiveness of efforts to reduce the stigma of mental illness may be increased by addressing their impact on perceived norms.

This case report describes a method for coronally repositioning gingiva for root coverage over the maxillary central incisors while simultaneously performing a frenectomy.The patient was a healthy 43-year-old Brazilian female. Her chief complaint pertained to the unesthetic appearance of the gingival recession involving both maxillary central incisors. Intraoral examination revealed a thick biotype with an adequate band of keratinized gingiva, Miller Class I mucogingival defects, and a broad frenum extending beyond the mucogingival junction. The surgical technique used to treat the areas of recession involved making semilunar incisions over the maxillary central incisors that blended into a frenectomy.Complete root coverage was achieved over the maxillary central incisors that initially presented with 2 mm of recession on the facial surface. The residual frenum no longer attached at a point coronal to the mucogingival margin. Small white scars were detectable at the mucogingival junctions above both incisors but were not an esthetic concern because of the patient's moderate smile line.This case report shows the possibility of applying a combined semilunar coronally repositioned flap with a frenectomy in a case in which maxillary central incisors were impinged upon by a broad aberrant frenum, probed/=3 mm, and presented with Miller Class I mucogingival defects. Further controlled investigations are needed to define the efficacy of this surgical technique.

Objectives:To investigate the relation of responses to the Schwartz Value Scale to preferred social distance to a person with either schizophrenia or depression. The influence of personal value priorities on discrimination has been investigated in several contexts, but seldom with reference to social distance towards those with mental illness.Method:University students ( n = 200) completed the Schwartz Value Scale, as well as a measure of beliefs about mental illness and preferred social distance with reference to a vignette describing a person with either schizophrenia or depression.Results:Consistent with past findings, respondents indicated a preference for greater social distance for schizophrenia than depression, and beliefs about likelihood of socially inappropriate behaviour and danger were correlated with social distance. Self-transcendence value orientation was a significant independent predictor of preference for less social distance. These findings were not influenced by a social desirability bias.Conclusions:Value orientation makes a significant contribution to the prediction of social distance towards those with mental illness. Evaluation of value-based interventions to reduce such discrimination appears warranted.

Past research on stigmatization of the mentally ill has emphasized the importance of beliefs about mental illness in determining preferred social distance to those with such illnesses. In the current paper we examine the importance of perceived social norms in improving the prediction of social distance preferences. Two hundred university students completed scales measuring their beliefs about either depression or schizophrenia; their perception of relevant social norms and their preferred level of social distance to someone with schizophrenia or depression. Measures of social desirability bias were also completed. The proportion of variance in preferred social distance was approximately doubled when perceived norms were added to beliefs about illness in a regression equation. Perceived norms were the most important predictor of social distance to an individual with either illness. A general preference for social distance towards a control, non-ill person was also an independent predictor of behavioral intentions toward someone with either schizophrenia or depression. Perceived social norms are an important contributor to an individual’s social distance to those with mental illness. Messages designed to influence perceived social norms may help reduce stigmatization of the mentally ill.

The level of ventilation (V E ) at a given carbon dioxide output (V CO2 ) determines ventilatory efficiency. During cardiopulmonary exercise testing (CPET), ventilatory efficiency can be measured as the slope of the V E versus V CO2 relationship or the lowest V E /V CO2 . We evaluated the test-retest reliability of these two ventilatory efficiency indices in 29 healthy subjects (14 males). Each subject performed duplicate cycle ergometer tests on different days. Ventilation and the gas fractions for oxygen and CO 2 were measured with a Vacumed metabolic cart. Linear regression analysis of the V E versus V CO2 slope for the duplicate tests in the males, females, and both sexes combined yielded correlation coefficients of 0·822, 0·942, and 0-910, respectively. The corresponding correlation coefficients for the lowest V E / V CO2 were 0·745, 0-929, and 0·884. A comparison of the test-retest correlation coefficients between the two ventilatory efficiency measures for the men, women, and both sexes combined revealed that they were not significantly different and, for a given index, there were no sex differences. The bias (mean of difference scores between tests) and 95% limits of agreement for the V E versus V CO2 slope in the males, females, and both sexes combined were -0·05 ± 2·41, -0-57 ± 1-92, and -0·32 ± 2·20, respectively. The bias and 95% limits of agreement for the lowest V E /V CO2 were very similar with values of 0-06 ± 2-45, -0-22 ± 2-03, and -0·10 ± 2-27. We conclude that the test-retest reliability for the V E versus V CO2 slope and the lowest V E /V CO2 is the same and that there is no sex difference in reliability for either index of ventilatory efficiency.

The authors examined the effects of uncertainty orientation on processing persuasive messages from minority sources versus majority sources. The authors gave participants a proattitudinal or counterattitudinal message that either a numerical majority or a numerical minority endorsed and that contained strong or weak arguments. In support of the hypothesis that was related to message scrutiny, uncertainty-oriented individuals engaged in greater message scrutiny when the Source-Position (i.e., minority/majority-pro/con) pairing was imbalanced (in majority-con, minority-pro conditions) than when it was balanced (in majority-pro, minority-con conditions). Certainty-oriented participants showed the opposite pattern, scrutinizing the message more when the situation was balanced than when the situation was imbalanced. Support for the hypothesis that was related to nonsystematic processing was less clear because the majority appeared to have played a greater role in accounting for the aforementioned interaction than did the minority. Additional analyses supported this interpretation. However, in all cases, individual differences in uncertainty orientation moderated strength and direction of information processing.

Persuasive messages often originate from in-group or out-group sources. Theoretically, in-group categories could facilitate heuristic-based message processing (because of the attractiveness of in-groups and their social reality cues) or systematic-based processing (because of high personal relevance of the message). The authors expected individual differences in uncertainty orientation and socially based expectancy congruence to be important variables in understanding these processes. Participants were exposed to strong or weak, in-group or out-group messages that were either expectancy congruent (in-group agreement, out-group disagreement) or expectancy incongruent (in-group disagreement, out-group agreement). As predicted, uncertainty-oriented participants increased systematic information processing under incongruent conditions relative to congruent (i.e., relatively certain) conditions; certainty-oriented individuals processed systematically only under congruent conditions. These findings suggest that uncertainty that has been created through social-categorization conflicts is treated differently by people of different personality styles.

Respiratory syncytial virus (RSV) remains a significant cause of morbidity, especially in premature infants and immunocompromised children, resulting in approximately 100 000 hospitalizations annually. A study was performed to evaluate the outcomes of those given palivizumab (Synagis; MedImmune, Inc., Gaithersburg, MD) during the 1998 to 1999 RSV season, its first season in general use.A retrospective chart review of 1839 patients from 9 United States sites was conducted, representing all patients given palivizumab at each site. Those evaluated were to have a gestational age ofor =35 weeks, were to be2 years old at their first injection and were to have received at least one dose of palivizumab (humanized monoclonal antibody against RSV) between September, 1998, and May, 1999. Gestational age, comorbidities, frequency of injections, hospitalizations and length of hospital stays were assessed.The antigen- or culture-positive RSV hospitalization rates for those given prophylaxis were 2.3% (42 of 1839) overall, 16/399 (4.0%) with chronic lung disease of infancy and 26 of 1227 (2.1%) born prematurely without chronic lung disease of infancy. Twenty-six patients had a gestational age of35 weeks and were included in the analysis.Only 2.3% of children receiving palivizumab prophylaxis were hospitalized with RSV lower respiratory infection. This compares favorably with the rates observed in the pivotal trial (IMpact-RSV trial in 1996 to 1997), in which prophylaxis reduced hospitalization from 10.6% in the placebo group to 4.8% in those children receiving prophylaxis.

The authors report their experience about laparoscopic surgery in the treatment of adrenal tumours. Three laparoscopic right adrenalectomies were performed. From a comparison with five open adrenalectomies, microinvasive surgery is more advantageous than traditional management: recovery is earlier, incisions are smaller, post-operative discomfort is less, physiologic functions recover in a short time, return to full professional activity in one week.

The solid papillary tumor of the pancreas is a relative rare neoplasm that often is unknown because of its diagnostic difficulties. It is frequent in young women. It has no typical clinical signs, sometimes produces abdominal mass, sometimes is found casually during investigations for other diseases. Instead the prognosis of this tumor is more typical: long-term survival is good. The natural history of the solid papillary is the same as neoplasm with a low malignancy potential. For this reason, it's important to make up a differential diagnosis between it and the other pancreatic tumors. Unlike the other malignancies, surgical conservative therapy is enough without making great demolitions of the pancreas. Lumpectomy gives a complete cure, decreasing surgical risk and dangerous functional complications. In the present paper, a case of solid papillary tumour of the pancreas is reported. It was diagnosed in a young woman and treated with simple lumpectomy. She is alive and disease free.

In 1982 Weinstein reported a syndrome marked by Hemolysis, Elevated Liver enzymes, Low Platelets (HELLP Syndrome). Following that report a critical review by MacKennaColl. reported that typical signs of the syndrome (observed in 223 cases of preeclampsia) were related to the preeclampsia so denying any nosografic autonomy to it. This report was confirmed by Killan that in 1974 described the classic HELLP syndrome as a complication of hypertensive syndrome in pregnancy. Our case report presents some patterns that may contribute to acquire new data in order to place the HELLP syndrome in its appropriate nosografic allocation.

Longitudinal observation of fasting triglyceride and total cholesterol levels throughout gestation in 16 type I, 13 type II, 11 GDM and 14 normal pregnant women was made. There were no significant differences between the groups examined, except the higher levels of triglycerides in GDM group during the second trimester (p less than 0.05). Probably these results are due to "good" metabolic compensation, achieved in diabetic pregnant women.

Guinea pig endometrial cells were isolated and maintained in cell culture. Our investigation of these cultures for the presence of epidermal growth factor (EGF) binding activity demonstrated that these cells possess EGF receptors. Upon the addition of EGF to growing cell cultures, an increase in the rate of cell growth resulted along with a higher saturation density. The binding of EGF to these cells is saturable at 40–50 ng/ml., and the receptors demonstrate “down-regulation” in response to hormonal challenge at 37°C.

This study was performed in order to delineate differences in kinetic enzyme characteristics of brain monoamine oxidase (MAO) and plasma cholinesterase (ChE) derived from the Walker-Walker (Fawn Hooded, FH) rat and from its putative ancestors, the Wistar (W) and Long-Evans (LE). As compared with the enzyme isolated from the other two strains, brain MAO from FH has both a higher Vmax and increased reaction rate at lower substrate concentrations. It may thus be described as a “more efficient” enzyme. This study confirms previous work which shows that plasma ChE activity of females is higher than that of males. Fluoride ion is a noncompetitive inhibitor of the Wistar ChE, is a competitive inhibitor of the FH enzyme, and has no effect on the LE enzyme. Dibucaine is a competitive inhibitor in all cases except one: ChE derived from the FH female is uncompetitively inhibited. A comparison of the inhibitor constants shows that FH ChE is more resistant to Dibucaine than is that of W, and that LE is the most sensitive. FH cholinesterase is twice as resistant to the action of fluoride as is the Wistar enzyme.

Further examination of rat pituitary cell line GH3/C14 showed that at least the physiologic concentration of L-thyroxine was required for estrogen-dependent growth in vivo. Two L-thyroxine synthesis inhibitors, 6-n-propyl-2-thiouracil (propylthiouracil) and 1-methylimidazole-2-thiol (methimazole), were administered concurrently with estrogen to GH3/C14-inoculated hosts. Propylthiouracil administration to estrogen-treated males, intact females, and estrogen-treated ovariectomized females inhibited tumor formation by 93, greater than 95, and 68%, respectively, as compared to tumor formation in controls not treated with propylthiouracil. Methimazole treatment of estrogen-primed males and intact females inhibited tumor formation by 78 and 95%, respectively. Concentrations of total L-thyroxine and free L-thyroixine in sera from normal and inhibitor-treated hosts were depressed 70-80% by propylthiouracil and 60-70% by methimazole. Administration of either drug caused greater inhibition of tumor growth than of total body weight gain. In addition, the administration of a combination of L-thyroxine and L-triiodothyronine to male rats promoted tumor formation even in the absence of exogenous estrogen.

A subclone of rat pituitary tumor cells, designated GH3/C14, was isolated from the parent population of GH3 pituitary cells and was estrogen-dependent for growth in vivo. GH3/C14 cells inoculated into host animals formed tumors in intact females, estrogen-treated ovariectomized females, and estrogen-treated males, but not in untreated intact or castrated males, or untreated ovariectomized females. Exogenous treatment with estrogens supported tumor formation in male animals. Radioimmunoassay of the average serum estradiol concentrations that support tumor growth in intact females, estradiol-treated intact females, and estradiol-treated intact males gave values of 41 +/- 4, 1,130 +/- 150, and 730 +/- 140 pg/ml, respectively. Tumor formation by GH3/C14 cells inoculated into male animals was not supported by either exogenous progesterone or hydrocortisone acetate. Further, these two steroid hormones had no significant effect on the estrogen-promoted growth in males or females. Exogenous testosterone treatment promoted tumor formation in males and ovariectomized females, but dihydrotestosterone was completely ineffective. Radioimmunoassay of the serum from tumor-bearing animals and the medium from the cells in culture showed that the cells produced growth hormone in vivo and in vitro but did not produce measurable amounts of luteinizing hormone or follicle-stimulating hormone. The groth of GH3/C14 cells in culture was examined in medium without added estrogen, and with estradiol added to the level of either the normal intact female rat or the estradiol-treated animals. No direct growth stimulation by estrogens could be detected in culture; the data suggested an indirect growth control mechanism.

Objectives To investigate the association between fasting idiopathic hypercalciuria (IHc), defined as IHc in the fasting state associated with normal parathyroid function, and ApaI, BsmI, and FokI polymorphisms of the vitamin D receptor (VDR) gene in 159 hypercalciuric recurrent stone formers. IHc contributes to the formation of calcium kidney stones in more than one half of reported cases. Methods We examined 62 patients with fasting IHc (24 women, mean age 42.8 ± 11.1 years, body mass index 25.7 ± 4.8 kg/m2), 97 patients with absorptive IHc (41 women, mean age 43.5 ± 10.8 years, body mass index 26.1 ± 4.4 kg/m2), and 124 healthy control subjects (52 women, mean age 41.9 ± 10.4 years, body mass index 25.4 ± 5.1 kg/m2) without a history of nephrolithiasis and without IHc. The bone mass density and VDR genotype and haplotype frequencies were determined in the studied populations. Results A reduced bone mass density was observed in fasting IHc patients compared with absorptive IHc patients (P = 0.009) and control subjects (P = 0.006). The prevalence of ApaI and BsmI VDR genotypes and alleles in patients with fasting IHc was significantly different statistically (P