Cardiac reactions to two psychological stressors, acting in combination

56 student volunteers (mean age 21 yr.) participated in a study designed to assess how the Stroop procedure and delayed auditory feedback affect cardiac activity when they are used individually as well as when they are combined in the same task. In a preliminary study, listening to tape-recorded instructions on how to relax produced a significant decrease in cardiac activity. In the major study, when used individually, both the Stroop procedure and delayed auditory feedback produced significant increases in cardiac activity. The largest increase, however, occurred with systolic blood pressure and was induced by delayed auditory feedback. When the Stroop procedure was used in combination with delayed auditory feedback, systolic blood pressure again increased, but this effect was no greater than when delayed auditory feedback was used alone. This pattern of results implies that, when combined, the Stroop procedure and delayed auditory feedback have largely independent effects on cardiac activity and that, when tested under similar conditions, delayed auditory feedback has the larger effect.

Clinical study of Multiload Cu375 in Pakistan

Three hundred and sixty five volunteers were observed for a total of 4882 woman-months for the clinical evaluation of MLCu375. Data were analyzed by life-table method at 6, 12 and 18 months. Most women were 21-30 years old, and of parity 2-4. Continuation rates of 78.2 and 68.8 at 12 and 18 months, respectively, and a pregnancy rate of 0.3% proved the device to be highly effective and well tolerated.

Carbon filament implants promote axonal growth across the transected rat spinal cord

Significant regeneration of neural pathways following complete transection of the spinal cord has yet to be demonstrated. In the present study, we analyzed the ability of carbon filaments to function as a scaffold for the regrowth of injured axons in the rat spinal cord. Through the use of three different axonal tracing methods, severed spinal axons were observed growing on and between carbon filaments implanted into the completely transected rat spinal cord. Carbon filaments, by providing a favorable adhesive surface and also a possible guiding function, may prove useful in the treatment of spinal cord injury.

Carbon filaments provide support and directionality to growing rat fetal spinal cord explants

Spinal cord explants obtained from 15 to 17-day-old fetal rats were cultured on bundles of 5-7 microns diameter carbon filaments attached to the bottom of Petri dishes. After a 3 week incubation period, the cultures were fixed and observed by light, scanning, and transmission electron microscopy. Neurites and glial processes were found to be growing both on and between the carbon filaments. The carbon filaments appeared to provide a biocompatible scaffold which promoted adhesion and gave directionality to the growing cell processes. These properties may make carbon filaments a suitable substrate for in vivo implantation into the damaged spinal cord.

Increased blood loss with in situ bypass

This study uses perioperative hematocrit determinations to quantitatively evaluate blood loss in patients undergoing either in situ (n = 37) or reverse vein technique (n = 44) for femorodistal popliteal or proximal tibial/peroneal reconstruction. The median drop in hematocrit was significantly greater on the fourth postoperative day in the in situ group as compared with the reverse vein group. The median drop in hematocrit was 8.8 +/- 4.2 per cent in the in situ group as compared with 4.8 +/- 4.1 per cent in the reverse vein group (P less than 0.0005). Blood transfusions were required in 11 of 37 patients (30%) in the in situ group as compared with five of 44 patients (11%) in the reverse vein group (P less than 0.05). Despite limitations of a retrospective study, our data indicate that there is greater blood loss with in situ technique as compared with reverse vein technique for femoropopliteal and crural reconstruction.

Microdose intravaginal levonorgestrel contraception: a multicentre clinical trial. IV. Bleeding patterns. World Health Organization. Task Force on Long-Acting Systemic Agents for Fertility Regulation

A multicentred clinical trial was conducted in 12 countries to assess the contraceptive efficacy and side effects of a low-dose levonorgestrel-releasing vaginal ring. Contraceptive efficacy and side effects, expulsions and removals, and the relation between pregnancy rate and admission body weight of the women have been reported previously. The effect of ring use on vaginal bleeding patterns as observed from daily menstrual diaries kept by the women is the object of this paper. A total of 1005 women were fitted with the ring and 702 of them provided a menstrual diary suitable for analysis. The description of the bleeding patterns is made using a 90-day reference period approach and following the guidelines published by WHO. In addition the longest bleeding/spotting episode and longest bleeding/spotting-free interval are calculated over the entire diary length. Half of the ring users have vaginal bleeding patterns similar to normal untreated patterns. A quarter experience irregular bleeding, 10% have prolonged cycles and 10% have shortened cycles. Over one year of continuous use, there appears to be no significant trend in these patterns. Users with the worst bleeding patterns tend to discontinue first during the clinical trial and are influenced by their more recent experience of vaginal bleeding irregularities. Life-table analysis of discontinuation rates gives an underestimation of the true incidence of bleeding irregularities. Some comments are made on the limitations of the methods of analysis of menstrual diaries.

Microdose intravaginal levonorgestrel contraception: a multicentre clinical trial. I. Contraceptive efficacy and side effects. World Health Organization. Task Force on Long-Acting Systemic Agents for Fertility Regulation

A multicentre clinical trial, including 19 centres in 13 countries, assessed the contraceptive efficacy and clinical acceptability of a Silastic 382 vaginal ring releasing 20 micrograms of levonorgestrel for at least 90 days. A total of 1005 women entered the study and 8176.74 woman-months of experience was gathered. The rate of intrauterine pregnancy at one year of use was 3.6 per 100 women (95% confidence interval 2.2-5.0), and of ectopic pregnancy, 0.2% (one case). The principal reasons for discontinuation were menstrual disturbances (17.2% at one year), vaginal symptoms (6.0%) and repeated expulsion of the ring (7.1%). The pregnancy rate with this 20 micrograms levonorgestrel-releasing vaginal ring compares favourably with that of a low estrogen combination oral contraceptive tested by WHO and is less than half that of a progestogen-only oral contraceptive in a WHO randomized study. It is concluded that the WHO intravaginal ring releasing an average of 20 micrograms of levonorgestrel per 24 hours is an effective method of contraception for at least one year of use.

Microdose intravaginal levonorgestrel contraception: a multicentre clinical trial. III. The relationship between pregnancy rate and body weight. World Health Organization. Task Force on Long-Acting Systemic Agents for Fertility Regulation

This paper investigates the relationship between pregnancy rates and body weight of 1005 women using a vaginal ring releasing 20 micrograms levonorgestrel per 24 hours. While the overall pregnancy rate at one year was 3.7%, it was found that women have an increasing risk of pregnancy with increasing body weight. For example, a woman of 40 kg has an estimated pregnancy rate of 1.7% in contrast to 9.8% for a woman of 80 kg weight.

Microdose intravaginal levonorgestrel contraception: a multicentre clinical trial. II. Expulsions and removals. World Health Organization. Task Force on Long-Acting Systemic Agents for Fertility Regulation

This paper investigates the relationship between expulsions and removals, and demographic characteristics of 1005 women from 19 centres using a vaginal ring releasing 20 micrograms levonorgestrel per 24 hours. Emphasis is placed on discontinuations of method use due to expulsions, on the number and rate of expulsions, and the time at which the first expulsion occurred. The overall life-table discontinuation rate due to expulsion was 7.1% at one year. Life-table discontinuation rates increased with parity and were highest in Asian and lowest in European women. In respect to the number of expulsions experienced by women (expulsions did not necessarily lead to discontinuation), the women of high parity and those from Asia and Europe have the highest rates. The life-table first expulsion rate is 29% at one year. Such rates are highest in Chinese and Asian women. Following a first expulsion, the second expulsion rate is 45% by the end of the subsequent six months. The majority of first expulsions occur at defaecation (134 or 57% of 234 women), urination (12%) and during menstruation (17%). Rings were removed by 121 (12%) women on 201 occasions and for a variety of reasons. The main medical reasons were vaginal discharge and irritation, bleeding pain and dyspareunia. Others removed the ring during defaecation, intercourse or because the ring came out of place. Women also removed rings for curiosity, to show their husbands and to clean.

A study of breastfeeding and the return of menses and pregnancy in Karachi, Pakistan

A longitudinal study of breastfeeding women was conducted to determine whether breastfeeding frequency is associated with the length of postpartum amenorrhea. The data are also conducive to testing the guidelines of the "Bellagio Consensus" (i.e., that there is no more than a 2% chance of pregnancy during breastfeeding in the first six months postpartum in the absence of vaginal bleeding and regular supplements). Twenty-eight breastfeeding women were followed-up weekly in Karachi, Pakistan. The frequency of breastfeeding was found to be a poor correlate of the duration of amenorrhea. Thirty-six percent of the women became pregnant during the study. However, all were having menses and/or giving regular supplements before the estimated date of conception, consistent with the Bellagio Consensus. In countries such as Pakistan, where contraceptive use is low, active promotion is needed to prevent the further decline of breastfeeding in order to retain its contraceptive as well as other maternal and child health benefits.

Urethral responses to sacral stimulation in chronic spinal dog

Urethral activity was investigated in the awake chronic spinal-injured canine using urodynamic recordings, video cystofluoroscopy, and urethral pressure recordings without anesthesia. Bladder contractions and voiding were induced by electrical stimulation with epidural electrodes inserted into the sacral canal. Urethral pressure remained elevated during stimulation and for 1-3 s afterward. Poststimulation voiding occurred with three different patterns: 1) pulsatile voiding in which squirting of urine was associated with contractions in the membranous urethra; 2) "on and off" voiding in which pulsatile flow was interrupted for brief periods of time; and 3) steady-stream voiding in which nonpulsatile flow was followed by pulsatile flow. Viewing these voiding patterns with fluoroscopy indicated that the proximal membranous urethra was important in all of the patterns. We conclude that in the chronic spinal-injured canine the skeletal muscle within the membranous urethra (rhabdosphincter) is involved in responses to sacral stimulation and various voiding patterns.

Sacral epidural electrodes for voiding in the chronic spinal dog

Recent reports have shown that electrical stimulation of the bladder wall or sacral nerves is effective for bladder management in the spinal cord injured (SCI) patient. However, less invasive methods are needed for electrode implantation. A modified percutaneous procedure for implanting needle electrodes in the sacral canal was evaluated. Stimulation with these electrodes were effective for inducing voiding with little residual volume after the recovery of bladder reflexes, 3 weeks after experimental spinal cord injury in the dog. An optimum electrode arrangement involved a single midline monopolar electrode located between sacral foramina L7 and S1. However, at low stimulating current, lateral electrodes adjacent to sacral nerves were more effective than midline electrodes for inducing voiding. Stimulation parameters that were effective for daily voiding were 10 pps, 1.5-5 mA, 0.3 ms pulse duration, and 2- to 3-second stimulation periods.

Increased axonal transport in peripheral nerves of thiamine-deficient rats

Thiamine deficiency has been implicated as a significant contributing factor in the development of peripheral neuropathies in chronic alcoholic patients. We hypothesized that thiamine deficiency may lead to an alteration in axonal transport because it has been associated with "dying-back" neuropathies and its importance in neural tissue has been demonstrated with antimetabolites. To test this possibility rats were made thiamine-deficient by feeding a liquid diet lacking thiamine. Control rats were pair-fed a complete liquid diet. The deficiency developed after 3 to 4 weeks and was evidenced by anorexia, weight-loss, and a significant increase in the erythrocyte transketolase activity ratio. Also, the sural nerve conduction velocity was found to be significantly reduced in these animals (18.74 m/s) relative to that of pair-fed control rats (31.99 m/s). In vitro transport experiments utilizing dorsal root ganglia-sciatic nerve preparations indicated that twice as much [35S]methionine-labeled protein accumulated at a ligation by fast transport in the thiamine-deficient rats as in nerves of their pair-fed controls. There was no difference in the level of incorporation of radioactive precursor into the dorsal root ganglia. The increase in transport suggests that thiamine deficiency per se has no detrimental effects on the transport machinery and process, but may indicate extensive regenerative activity in the distal portions of these axons.

Effect of injury on nerve growth factor uptake by sensory ganglia

The level of the nerve growth factor protein, NGF, in vivo has a profound influence on axonal sprouting by sensory neurons of vertebrate dorsal root ganglia. There is evidence also that NGF may play similar roles in cholinergic central structures in brain. In both instances, retrograde transport of NGF has been demonstrated. Here we examined uptake of NGF by DRG neurons in response to contusion injury of the spinal cord. Under these conditions there was uptake and transport of NGF into large DRG neurons via central processes but no uptake by non-DRG central neurons. Thus, any effects of NGF on spinal neurons or their processes would be secondary to the direct effects of NGF on DRG neurons.

Ultrastructural changes in rat aortic endothelium during contrast media infusion

A rat model was employed to investigate contrast media (CM) induced ultrastructural changes in the vascular endothelium. Ionic contrast materials such as Renografin-76 (diatrizoate meglumine diatrizoate sodium), MD-76 (diatrizoate meglumine diatrizoate sodium), and Angiovist (meglumine diatrizoate) were injected into the femoral vein of anesthetized male Wistar rats (240-260 g) and allowed to circulate. Control animals were similarly injected with equiosmolar sucrose and physiologic saline. The thorax was opened 15 minutes, 1 hour, and 4 hours postinjection and cardiac perfusion performed using Karnovsky's fixative; the thoracic aorta was then surgically removed, and processed for transmission electron microscopy. All CM produced shrinkage in cell cytoplasm and nuclear structures thereby causing distortions in cell morphology. In control tissues, however, no such ultrastructural damages were noted. Within 15 minutes of CM infusion, electron dense granules were seen on the luminal surface of endothelial cells, in pinocytotic vesicles, as well as in the gap junctions between cells. These observations indicate that contrast media intake occurs via vesicular transport, and through the cell junction.

Internal mammary implantation: the need for revival of a simple technique

Available statistics on breast cancer indicate a high frequency of positive internal mammary nodes, which is associated with decreased five-year survival rates. The close proximity of the majority of internal mammary nodes (87 percent within 1 cm) to the internal mammary vessels makes them easily accessible to high-dose intravascular continuous irradiation by afterloading radioactive ribbons (iridium 192) in the internal mammary vessels that are surgically exposed. This is a simple technique that can be carried out at the time of mastectomy or as a separate procedure, either as a primary radiation modality, for post-XRT recurrence, or as a boost in combination with conventional parasternal radiation therapy. The step-by-step technique, indications, need for revival, and future implications are presented.

Estrogen and progesterone receptors in breast cancer in Black Americans: Correlation of receptor data with tumor differentiation

It has been observed that 60-70% of breast cancer patients have estrogen receptors (ER) and that nearly two-thirds of such patients respond favorably to endocrine therapy. Cytosolic ER and progesterone receptors (PgR) have been evaluated in the current study, among 146 black women with breast cancer in order to determine whether the distribution of ER and PgR differs from the national norm. The results showed following trends that were similar to reports from other institutions: (1) postmenopausal patients and primary tumors showed higher ER positivity than premenopausal patients and metastatic sites, respectively; (2) a significant correlation between the ER positivity and tumor grade; and (3) a higher PgR positivity in ER-positive patients than in ER-negative patients. However, statistically significant differences were observed in three parameters when compared to reports from other institutions on white patients: (1) a low incidence of ER-positive (46%) and high incidence of ER-negative (42%) tumors; (2) a higher incidence of poorly differentiated (55.5%) and a lower incidence of well differentiated (5.5%) tumors; tumor grade was independent of age, menopausal status, histopathology and stage; and (3) a higher percentage of patients discovered at a more advanced stage of the disease. The clinical implications of these results in explaining the relatively poorer survival of black women with breast cancer compared to whites is discussed. Whether this high incidence of PD tumors and thus a high incidence of ER negativity is due to ethnic differences and/or environmental and other factors remains to be elucidated.

Tumors of extramammary breast tissue

Polymastia is described and tumor formation in this condition is discussed. Two cases of carcinoma is aberrant breast tissue and one of fibroadenoma in a supernumerary breast are reported.

Follicular carcinoma of the thyroid with metastasis to the breast

A 75-year-old woman with two previous neck operations for follicular carcinoma of the thyroid presented with a breast mass nine years after diagnosis. The mass recurred one month after excisional biopsy. Pathological examination revealed metastatic follicular carcinoma. The breast tumor was weakly positive for estrogen receptor and positive for progesterone receptor. Recurrences in the neck and breast were resected. Residual disease in the neck and metastasis to the lungs were resolved by (131)I ablative therapy. Previous reports of thyroid metastasis to the breast were described as papillary carcinoma. This report describes a rare site of metastasis and briefly reviews the pathology, diagnosis, and management of thyroid carcinoma.