Determinants of bone density and prevalence of osteopenia among female runners in their second to seventh decades of age.

This is a cross-sectional study of spine and hip bone density (BMD) in 124 female athletes, aged 16-68 years, who trained for at least 3 hs/week. The aim was to document the effects of competitive running on BMD in women over a broad age range. Thirty-three subjects, aged <35 years, were currently oligo- or amenorrheic and, of the 50 who were >40 years, and who were now menstruating normally, 13 had previously been oligo- or amenorrheic.

Modulation of protein metabolism in the surgical patient. Effect of 48-hour continuous epidural block with local anesthetics on leucine kinetics.

Background And Objectives: To quantitate the possible nitrogen-sparing effect induced by continuous epidural block during the flow phase of surgical trauma, protein kinetics were measured in patients undergoing colorectal surgery and receiving a constant protein intake.

Methods: Epidural block was established in two groups of eight patients each before surgery with 0.75% bupivacaine, and after surgery sensory analgesia (T4 to S5) was maintained with 0.

Vasodilating beta-blockers in heart failure.

Carvedilol is a non-selective beta-adrenoceptor antagonist with vasodilating properties which has been shown to be effective in the management both of hypertension and of stable angina pectoris. In order to explore its wider efficacy in patients with manifest heart failure, a preliminary study was performed in patients with chronic stable angina pectoris accompanied by abnormal left ventricular wall motion, but without overt heart failure (mean ejection fraction < 40%). Six patients were given carvedilol 25 mg b.

Increase in Mallampati score during pregnancy.

A photographic version of the Mallampati test was developed and applied to 242 pregnant patients at 12 weeks' gestation and again at 38 weeks' gestation. At 38 weeks the number of grade 4 cases had increased by 34% (P < 0.001).

Diagnosing respiratory syncytial virus by nasal lavage.

Nasal lavage was compared with nasopharyngeal aspiration for diagnosis of respiratory syncytial virus infection. Nasal lavage and nasopharyngeal aspiration were performed on 50 occasions in 32 infants (median age 5.6 months) with acute viral wheezing.

Reverse redistribution of thallium-201 represents a low-risk finding in thrombolysed patients following myocardial infarction.

The aim of the study was to evaluate the prevalence and clinical significance of reverse redistribution on thallium-201 imaging in post-myocardial infarction patients who have undergone thrombolytic therapy. Sixty-two patients aged 35-79 (mean 60) years with proven myocardial infarction who had undergone thrombolysis were studied 6 weeks post infarction. Standard stress and 4-h redistribution imaging was performed with 201Tl following treadmill exercise.

The small bowel follow-through: time to sit up.

It is common practice for patients to lie on their right side during small bowel barium follow-through examinations. The rationale is that this speeds up transit time and improves diagnostic usefulness. The results of a randomized, prospective study of 105 patients are presented.

Temporomandibular joint dislocation and deafness from a cricket ball injury.

Cricket is a national sport in some countries and can be potentially hazardous. We report an incident of a cricket ball impact to the chin, which resulted in posterior dislocation of both temporomandibular joints and bilateral mixed deafness. There appear to be no similar case reports in the literature.

Myocardial single-photon emission computed tomographic imaging with technetium 99m tetrofosmin: stress-rest imaging with same-day and separate-day rest imaging.

Background: Technetium 99m tetrofosmin is a new ethylene diphosphine ligand for myocardial perfusion imaging and has unique properties. We have compared stress-rest single-photon emission computed tomographic (SPECT) imaging with 99mTc tetrofosmin with same-day and separate-day rest imaging to detect myocardial perfusion defects.

Methods And Results: Myocardial SPECT imaging was performed in 22 patients with coronary artery disease who had undergone planar thallium 201 imaging and coronary angiography.

Tumour necrosis factor-alpha and leukotriene E4 production in wheezy infants.

It is not clear why certain infants wheeze during viral upper respiratory tract infections (URTIs) but it is possible that they have a tendency to mount an exaggerated inflammatory response leading to production of mediators that induce airway narrowing. We studied nasal tumour necrosis factor-alpha (TNF alpha) and urinary leukotriene E4 (LTE4) production during infection and after recovery in 31 wheezy infants (median age 6.2 months).

Cutaneous sarcoid-like granulomas in primary immunodeficiency disorders.

We report the occurrence of cutaneous sarcoid-like granulomas in one patient with common variable immunodeficiency and another with 'thymoma and hypogammaglobulinaemia'. To our knowledge, this is the first time that such skin lesions have been described in patients with primary immunodeficiency. These granulomas may be attributed to a combination of interleukin-2 deficiency and a profound CD4 lymphopenia.

Potent hemodynamic effects of bimakalim, a new potassium channel opener, in humans.

The cardiac hemodynamic effects of bimakalim, a new potassium channel opener, were evaluated in 12 normal volunteers by echocardiography (ECHO)/Doppler in a placebo-controlled, randomized double-blind, cross-over, dose-ranging study. A single oral dose (0.25-1 mg) was given at weekly intervals.

Nasal IgA response in wheezy infants.

It is unknown why some infants wheeze during upper respiratory tract infections. One possibility is that secretory IgA, which has a major role in mucosal defence against viral infection, might be deficient in wheezy infants. The nasal IgA response to upper respiratory tract infection in 32 wheezy infants (median age 5.

Clinical evaluation of the oesophageal heat exchanger in the prevention of perioperative hypothermia.

We have studied the efficiency of an oesophageal warming device in the prevention of perioperative hypothermia in 22 patients undergoing total hip replacement. Aural canal and skin temperatures (15 sites) were measured before induction of anaesthesia, at the end of surgery and 1 h after recovery and mean body heat was calculated to quantify heat distribution. Core temperature decreased significantly in both groups at the end of surgery, by a mean of 1.

Continuous spinal anesthesia: dose requirements and characteristics of the block.

Background And Objectives: A fine-bore 28G CoSpan spinal catheter was used to provide continuous spinal anesthesia for major upper and lower abdominal, peripheral vascular, and orthopedic surgery in 90 patients, aged 31-91 years.

Methods: Initial doses (0.5-2.

Intra-arterial monitoring of the antihypertensive effects of once-daily amlodipine.

Amlodipine is a dihydropyridine calcium antagonist with a long elimination half life making it suitable for once-daily dosing. This study used sphygmomanometric and intra-arterial ambulatory blood pressure (BP) monitoring to confirm the antihypertensive effect of a once-daily dose of amlodipine over the dosing interval. After a 2-week single-blind placebo run in, amlodipine was administered to 11 patients at a starting dose of 5 mg daily for 2 weeks increasing to 10 mg daily for a further 4 weeks if diastolic blood pressure (DBP) measured sphygmomanometrically was not < 90 mmHg or decreased by > 10 mmHg from baseline values.

Interactions of tumor necrosis factor with granulocyte-macrophage colony-stimulating factor and other cytokines in the regulation of dendritic cell growth in vitro from early bipotent CD34+ progenitors in human bone marrow.

Colonies of CD1a+ HLA-DR+/DQ+ CD4+ cells with the functional and some of the structural attributes of Langerhans cells are observed in human bone marrow cultures in semi-solid media and are assumed to be the progeny of an early progenitor, the dendritic/Langerhans cell CFU (CFU-DL). The cytokine-regulated growth of these cells has been studied using a chemically defined serum-free system to culture both unfractionated and highly enriched bone marrow progenitor cell populations. Although unfractionated cell growth was optimal in serum replete cultures with PHA-stimulated leukocyte-conditioned medium (PHA-LCM) suboptimal proliferation of CFU-DL was observed in serum even in the absence of PHA-LCM.

How common are polycystic ovaries in normal women and what is their significance for the fertility of the population?

Objective: We wished to determine the prevalence of polycystic ovaries (PCO) and relate morphological appearance to fertility.

Design: We sent postal invitations to a random sample of women born in the years 1952-1969 from a list of a single Group Practice to attend for reproductive history questionnaire, examination, ultrasound scan of the ovaries and hormone measurements within 5 days of the onset of menstruation.

Subjects: Of 1065 women potentially available for study, 571 (54%) replied of whom 353 (62%) agreed to participate.

Direct versus indirect measurement of blood pressure.

The indirect method of blood pressure measurement is known to be potentially inaccurate, slow-moving and incapable of recognizing artefacts such as the 'alerting reaction'. This situation can be improved by repeated measurements, with, for example, ambulatory non-invasive measurement. Nevertheless, these clinic blood pressure measurements are known to supply very good prognostic information, at least in large populations, and it has yet to be established that ambulatory monitoring can supply better prognostic data.

Coeliac disease presenting with cerebellar degeneration.

A case of rapidly progressive cerebellar degeneration with bilateral sixth nerve palsies is described in whom investigation revealed the presence of unsuspected coeliac disease. In spite of treatment with a gluten free diet, rapid fatal deterioration occurred. Coeliac disease should be considered in patients with encephalopathy of obscure origin.