Relation of age to left ventricular function in clinically normal adults.

The extent to which age, independent of cardiovascular diseases, influences left ventricular (LV) function in adults is uncertain. Echocardiograms and simultaneous arterial pressure in 464 clinically normal adults aged 16 to 88 years were used to measure LV dimensions, endocardial and midwall LV fractional shortening, stroke volume, cardiac output, and circumferential end-systolic stress. The ratios of observed endocardial and midwall shortening to values predicted for observed end-systolic stress were used as measures of chamber and myocardial function.

Long-term depot medroxyprogesterone acetate (Depo-Provera) use in inner-city adolescents.

Purpose: To determine Depo-Provera continuation rates and reasons for its discontinuation among adolescents.

Study Design: Medical record reviews and telephone interviews with 159 adolescents who initiated Depo-Provera use between 1 December 1992 and 31 December 1995 at two clinics in New York City. Depo-Provera continuation was measured using lifetable analysis.

A genetic defect resulting in mild low-renin hypertension.

Severe low-renin hypertension has few known causes. Apparent mineralocorticoid excess (AME) is a genetic disorder that results in severe juvenile low-renin hypertension, hyporeninemia, hypoaldosteronemia, hypokalemic alkalosis, low birth weight, failure to thrive, poor growth, and in many cases nephrocalcinosis. In 1995, it was shown that mutations in the gene (HSD11B2) encoding the 11beta-hydroxysteroid dehydrogenase type 2 enzyme (11beta-HSD2) cause AME.

Is routine duplex ultrasound surveillance after carotid endarterectomy cost-effective?

Background: Although duplex ultrasound surveillance of patients after carotid endarterectomy (CEA) is routinely performed, the use of this policy has been questioned. We evaluated the cost-effectiveness of this strategy.

Methods: Using a decision-analytic Markov model that depicts the natural history of patients after CEA, we compared a strategy of duplex ultrasound surveillance to a strategy of no surveillance.

Placental pathology in systemic lupus erythematosus: a prospective study.

Objectives: Systemic lupus erythematosus and antiphospholipid antibody, often identified in patients with systemic lupus erythematosus, are associated with poor pregnancy outcome. This study distinguishes between the effect of each of these factors on gestational outcome and placental pathologic conditions in pregnant patients with systemic lupus erythematosus.

Study Design: Thirty-seven pregnancies and 40 placentas from 33 women with systemic lupus erythematosus were studied prospectively.

"Healthy avenues of the mind": psychological theory building and the influence of religion during the era of moral treatment.

Objective: This article delineates the main psychological interventions used by American asylum superintendents practicing moral treatment between 1815 and 1875. Further, it explores the impact of Protestant religious ideas on specific aspects of moral treatment's theory and practice.

Method: Asylum annual reports written by superintendents (physicians dedicated to the treatment of the mentally ill) were studied along with volumes of the American Journal of Insanity from its premier issue in 1844 through the 1890s.

Appendiceal CT in 140 cases. Diagnostic criteria for acute and necrotizing appendicitis.

Computed tomography (CT) was performed in 140 patients with suspected acute appendicitis. Thin collimation (5 mm), intravenous contrast enhancement, 1-second scan times, and supplementary cecal air insufflation were emphasized. CT accuracy was 98% overall (137/140), and 99% in the 124 cases with early surgery.

The nature and predictors of substance use among lesbians.

It has been suggested that lesbians lack mainstream coping resources and are thus at risk for maladaptive coping efforts, which include substance abuse, However, data for thus at risk for maladaptive coping efforts, which include substance abuse. However, data for this population are sparse. Levels of stress, coping styles, rates of problematic substance use and relationships among these variables were examined.

Oocyte donation: does a previous attempt affect a subsequent attempt?

Objective: To analyze the effect of a previous donor oocyte cycle on the outcome of subsequent attempts.

Design: Retrospective study.

Setting: Oocyte donation program at The New York Hospital/Cornell Medical Center.

H-Y antigen expression patterns in human X- and Y-chromosome-bearing spermatozoa.

Problem: Restricted expression of H-Y antigen on Y-chromosome-bearing sperm has been reported in some species, although such preferential expression for H-Y antigen in human sperm has yet to be described. In this study, an immunomagnetic approach was used to characterize antigen expression patterns as a function of sex-chromosome content.

Method Of Study: Human sperm was treated with monoclonal immunoglobulin (Ig) M antibodies directed against H-Y antigen.

Chronic administration of OB protein decreases food intake by selectively reducing meal size in female rats.

The mechanisms by which OB protein controls food intake and energy balance are unknown. Therefore, we investigated the effects of a novel modified human recombinant OB protein (Mod-OB) on spontaneous feeding patterns, body weight, running wheel activity, and ovarian cycling in female rats. Mod-OB or vehicle was injected (4 mg .

Ontogeny of neuropeptide Y expression in response to deprivation in lean Zucker rat pups.

Hypothalamic neuropeptide Y (NPY) activity is believed to play an important role in the response to food deprivation in adult rats. Little is known, however, about the role of the hypothalamic NPY system in the control of food intake in the preweanling rat. To address this issue, we examined the effect of deprivation on arcuate nucleus preproNPY expression in lean Zucker rat pups, using in situ hybridization.

Familial retinoblastoma: where and when?

Purpose: To determine when patients with a family history of retinoblastoma and previously normal eye exam develop intraocular disease, and where the new retinoblastoma tumors occur.

Methods: A retrospective chart review of retinoblastoma patients.

Results: Sixty-two percent of the first eyes (eyes having a previously normal examination) were diagnosed with retinoblastoma by 6 months of age, 90% by 12 months and 100% by 28 months.

The physician as ambivalent Samaritan: will internists resuscitate victims of out-of-hospital emergencies?

To determine how internists would respond to out-of-hospital emergency medical situations, we surveyed internal medicine residents and attending physicians at urban academic medical centers regarding their willingness to help in five such scenarios. For those scenarios in which they were reluctant to help, they were asked why. Knowledge of Good Samaritan statutes was also assessed.

p53 gene mutation in the bone-marrow of a patient with diffuse mixed cell type lymphoma at diagnosis predicting eventual progression to large cell lymphoma.

Mutations of the p53 tumor suppressor gene have been used as molecular genetic markers of disease and serve as a prognostic indicator in various malignancies including non-Hodgkin's lymphoma (NHL). Alterations in the p53 gene were investigated in a bone marrow sample from a NHL patient admitted for autologous bone marrow transplantation. Diffuse mixed small and large cell NHL, was initially diagnosed which eventually progressed to large cell lymphoma at relapse following poly-chemotherapy.

Poorly differentiated insular thyroid carcinoma. A case report with identification of intact insulae with fine needle aspiration biopsy.

Background: Subsequent to the publication of a report in 1984 entitled "Poorly Differentiated ("Insular") Carcinoma: A Reinterpretation of Langhans "wuchernde Struma," poorly differentiated insular thyroid carcinoma (PDITC) has become recognized as a distinct thyroid neoplasm. It is classified morphologically and biologically as an intermediate entity between well-differentiated (papillary and follicular) and undifferentiated (anaplastic) thyroid carcinomas. Only a few publications have addressed the findings with fine needle aspiration biopsy (FNAB).

Pre-clinical cardiovascular disease and surrogate end-points in hypertension: does race influence target organ damage independent of blood pressure?

Objectives: To examine the adequacy of available evidence that: 1) left ventricular hypertrophy (LVH) and its regression influence the rate of cardiovascular events in hypertension; 2) carotid artery wall thickening and discrete plaque have comparable significance to LVH; and 3) black hypertensive patients have greater target organ damage than white hypertensives, independent of blood pressure and other relevant covariates.

Design And Methods: Statistical, epidemiologic, and treatment trial literature concerning ECG and echocardiographic LVH and carotid ultrasound findings was reviewed to address the above three questions.

Results: Results of seven electrocardiographic and ten echocardiographic studies (total of 20,000 subjects) show consistently higher risks of morbid events in individuals with LVH as compared to those without (odds ratios 1.

Intermittent, repetitive corticosteroid-induced upregulation of platelet levels after adenovirus-mediated transfer to the liver of a chimeric glucocorticoid-responsive promoter controlling the thrombopoietin cDNA.

For many in vivo gene therapy clinical applications, it is desirable to control the expression of the transferred transgene using pharmacologic agents. To evaluate the feasibility of accomplishing this using corticosteroids, pharmacologic agents widely used in clinical medicine, we constructed replication deficient adenoviral (Ad) vectors containing an expression cassette with a chimeric promoter comprised of five glucocorticoid response elements (GRE) and the chloramphenicol acetyltransferase reporter gene (AdGRE.CAT) or the murine thrombopoietin cDNA (AdGRE.

Ethical dimensions of ultrasound screening for fetal anomalies.

The ethical dimensions of the debate on routine ultrasound are analyzed. The central role of the informed consent process, based on a respect for the autonomy of the pregnant woman, is presented. Failure to offer quality ultrasound in clinical settings where it is available restricts access to pregnant women to the diagnosis of fetal anomalies and therefore restricts access to the options of abortion and fetal therapy.

Prenatal diagnosis of gastrointestinal anomalies with ultrasound. What have we learned?

The use of routine obstetric ultrasound has been shown to accurately diagnose fetal gastrointestinal anomalies, both during and after the midtrimester. These are among the most accurately diagnosed of all anomalies, comprising 5-7% of all fetal anomalies. From a review of the literature it is clear that the use of routine ultrasound allows: (1) the detection of multiple anomalies that are often present and affect outcome significantly, (2) preparation for delivery at a tertiary center where neonatal surgical experience will allow optimal outcome, and (3) decisions about mode and timing of delivery in cases where this is important, i.