Postnatal depression, eating, exercise, and vomiting before and during pregnancy

OBJECTIVE

To examine the postnatal distress and the eating, exercise, and weight losing behavior of women before and during pregnancy.

METHOD

The subjects were healthy women who had given birth to a singleton healthy baby in the week before the study. They were drawn from two consecutive series of mothers of babies whose birth weights were either < or =2,500 g or >2,500 g. A total of 181 women were interviewed using a standardized interview modified for pregnancy and related behaviors. They also completed the Edinburgh Postnatal Distress Questionnaire.

RESULTS

Regression analysis produced a final model containing variables that made a unique contribution to predicting the level of distress of women in the week following childbirth. The model accounted for 25% of the variance and included four variables that were associated with greater distress: fear of weight gain before and during pregnancy, being distracted by thoughts of food during pregnancy, being afraid of gaining more weight than the pregnancy would explain, and vomiting more frequently during the first 3-4 months of pregnancy. A fifth variable accounted for less distress, that is, participating in low-intensity exercise for reasons of shape and weight during months 3-4 of pregnancy. Other variables associated with distress only in the preliminary analysis were maternal age, binge eating, and vomiting before pregnancy. The most distressed mothers were suffering from an eating disorder at the time of pregnancy. The binge and/or purge type of eating disorder was associated with more distress than a food restriction type.

DISCUSSION

Postnatal distress is associated with body weight and shape concerns, with disordered eating before and during pregnancy, and with vomiting during pregnancy. The protective role of low-intensity exercise during early pregnancy needs to be explored. Women with eating disorders should be considered at risk for postnatal problems.

Primary cardiac lipoblastoma

Lipoblastoma is a benign adipose tumor in children that has been described in various anatomic locations, most commonly the extremities. We describe the case of a 17-month-old boy diagnosed with cardiac lipoblastoma, a previously unreported primary cardiac tumor in children. Our patient presented with symptoms of coughing, wheezing, and hoarseness and was found to have a large mediastinal mass, which narrowed the left mainstem bronchus and compressed the right atrium and superior vena cava, causing superior vena cava syndrome. Surgical exploration revealed an intrapericardial soft tissue mass arising from the area of the posterior interatrial septum. Grossly, the resected mass was lobulated, pale yellow, and fatty with focal areas of gray myxoid tissue. Microscopically, the tumor consisted of both immature and mature adipocytes, with focal vascular myxoid areas containing lipoblasts, diagnostic of lipoblastoma. Two months after surgery, the patient was in good health without evidence of recurrence.

Antibody response to a single tetanus toxoid booster in young women in rural south India

BACKGROUND

Tetanus toxoid immunization is an integral part of the maternal and child health programme in developing countries. It is likely that many women may have had childhood immunization and so already have antitetanus antibodies at the time of their first antenatal visit. A single dose of tetanus toxoid injection can boost the levels of antitetanus antibodies in these women. This study was undertaken to assess the previous immunization status by verbal history and assess the effect of a single tetanus toxoid injection in young women.

METHODS

Ninety-nine unmarried women between 18 and 22 years of age were enrolled for the study. The history of childhood immunization was obtained from their mothers. Blood samples were collected to measure IgG antibody levels to tetanus using ELISA. Antibody levels were also measured on day 14 after a dose of tetanus toxoid injection.

RESULTS

Of the 99 women studied, 81 had a history of childhood immunization while 18 did not. Overall, 92% of the women had protective levels of antibodies at the time of first testing and 99% of the women were protected with a single dose of tetanus toxoid.

CONCLUSION

In areas with good maternal and child health services, a single booster dose of tetanus toxoid can be considered adequate for primigravidae with a history of childhood immunization.

Body mass index, menarche, and perception of dieting among peripubertal adolescent females

OBJECTIVE

To examine perceptions of dieting among pre and postmenarchial female school students.

METHOD

All 51 female students of mean (SD) age 12.6 (0.6) years from a state school volunteered to complete a questionnaire about general health, eating and weight control behaviors, and menstrual status. Height and weight were measured. Focus groups using structured questions and discussion were used to elicit responses about the meaning of dieting and its association with menarche.

RESULTS

Postmenarchial females were significantly more likely than the same age premenarchial students to have increased their body mass index (BMI), to clearly articulate the meaning of dieting, to report trying to lose weight, and to use diet and exercise to lose weight. Premenarchial females did not have a clear perception of dieting. Premenarchial females who reported trying to lose weight equated dieting with healthy eating and did not include losing weight or the behaviors and feeling associated with the concept of dieting unless their BMI had increased and menarche was imminent.

DISCUSSION

The concept of dieting that may result in weight loss and the behaviors and feelings associated with dieting did not develop until menarche and is likely to be associated with the rapid increase in height, weight, and body fat that precedes menarche. Educational interventions aimed at preventing eating disorders among premenarchial adolescents may therefore be inappropriate, ineffective, and potentially dangerous.

Altered energy metabolism in anorexia nervosa

Optimal nutritional rehabilitation of anorexia nervosa requires more information concerning actual energy and substrate requirements. To this end, indirect calorimetry was performed in female patients (n=34, age 20.9+/-1.2 yr, body mass index [BMI] 15.6+/-0.2 kg/m(2); mean+/-SEM) soon after commencement of refeeding and at the time of discharge from hospital (n=18, BMI 19.0+/-0.3 kg/m(2)). Healthy female controls (n=18, age 24.6+/-1.3 yr, BMI 21.6+/-0.6 kg/m(2)) were also tested. Resting energy expenditure (REE) and respiratory quotient (RQ) were measured in the fasting state, followed by diet-induced thermogenesis (DIT) and RQ over a 4 h period following a 100 g oral glucose load. Compared with post-refeeding patients and controls, pre-refeeding patients had a high basal RQ and a low REE, with a paradoxically higher DIT (13.2+/-0.9% of REE vs. 8.3+/-1.2% and 8.6+/-0.9% in post-refeeding patients and controls, respectively). RQ values in pre-refeeding patients exceeded unity following the glucose load, probably reflecting net lipogenesis, whereas in the post-refeeding patients, post-glucose RQ was similar to that of controls, suggesting premature curtailment of lipogenesis. These data demonstrate energy wasting in emaciated patients with anorexia nervosa. Biological repair processes could account for disproportionate energy loss early in refeeding and there may be some later impediment to full restoration of fat stores.

Differential DNA binding and transcription modulation by three T-box proteins, T, TBX1 and TBX2

T-box genes encode a family of phylogenetically conserved DNA-binding proteins that regulate gene expression during embryogenesis. While the developmental importance of many T-box genes has been well documented, little is known about how family members differ in their DNA binding properties and ability to modulate transcription. Here we show that although TBX1, TBX2 and the Xenopus T protein (Xbra) share only 50-60% identity within their DNA-binding domains they can bind the same DNA sequence in vitro. However, the proteins differ in three important respects. While TBX1 protein binds a palindromic T oligonucleotide as a dimer, as had been previously reported for Xbra, TBX2 appears to bind the same DNA sequence as a monomer. Also, T protein/DNA complexes are stabilized in vitro by the addition of specific antibodies, whereas TBX2/DNA complexes are not stabilized by antibodies. Most importantly, TBX2 represses while Xbra activates transcription of the same chimeric reporter plasmid. TBX1, although capable of binding to the chimeric promoter, has no effect on transcription. Thus, while the DNA binding domains of T-box proteins share substantial homology, these proteins differ in both their DNA binding and transcriptional modulation properties. These results suggest that the various T-box proteins, while highly conserved, likely use different mechanisms to modulate transcription and may have different targets in vivo.

Transradial cardiac catheterization in elderly patients

The safety and efficacy of transradial cardiac catheterization in elderly patients is unknown. This study examines procedure success rates for transradial catheterization in appropriately selected patients < 70 (n = 195) and >/= 70 (n = 83) years old. Elderly patients were less likely to be selected for the transradial approach (46% vs. 61%; P = 0.05). Although patients >/= 70 years old were more often female (39.7% vs. 24.1%; P = 0.008) and had a smaller body surface area (1.89 +/- 0.18 vs. 2.01 +/- 0.24 m2; P = 0. 001), procedure success rates did not differ (95.1% vs. 94.8%; P = NS). Procedure-related variables including procedure time (15.4 +/- 12.6 vs. 16.1 +/- 11.6 min; P = NS), amount of radiographic contrast (90.1 +/- 31.9 vs. 86.4 +/- 29.8 cc; P = NS), and number of catheters used (1.5 +/- 0.9 vs. 1.5 +/- 0.7; P = NS) were similar between groups. We conclude that transradial catheterization can be safely and effectively performed in selected elderly patients. Cathet. Cardiovasc. Intervent. 51:287-290, 2000.

The reality of unsafe abortion in a rural community in South India

Though the law in India has permitted medical termination of pregnancy on broad legal grounds for over two decades, unsafe abortions carried out by unqualified providers show no signs of decreasing. A community-based study was undertaken in rural South India to determine the prevalence of induced abortion, women's reasons for seeking abortion, who was providing abortions and whether the procedures were safe or unsafe. A cross-sectional study design was used that included focus group discussions with 88 women and a quantitative survey with 195 married women who had a birth interval of two or more years since their last pregnancy. There was a high prevalence of induced abortion (28 per cent) among the study population, mainly among women who were not using contraception. Most abortions were carried out in the first trimester of pregnancy and unqualified practitioners performed 65 per cent of terminations. The preference for illegal, untrained providers in a country where abortion is legally available exposes the ambiguity in the status of abortion and how inadequacies in legal service provision have served to promote and sustain unsafe providers and practices. An integrated approach to family planning and reproductive health which includes abortion is imperative if the reproductive health status of Indian women is to be improved. The poor utilisation of existing government facilities suggests the need for improving the quality of services, expansion of abortion facilities and the introduction of safer methods of abortion. To do this, a re-examination and re-framing of aspects of the 1971 abortion law is needed.

Chemoembolization of liver tumor in a rabbit model: assessment of tumor cell death with diffusion-weighted MR imaging and histologic analysis

PURPOSE

To assess the efficacy of chemoembolization of liver tumors by determining the fraction of viable tumor cells remaining after treatment with use of diffusion magnetic resonance (MR) imaging and histologic analysis.

MATERIALS AND METHODS

VX2 tumor was grown in the livers of 12 rabbits. Animals were divided into a chemoembolization group and an untreated group. Conventional, perfusion, and diffusion MR imaging was performed on all rabbits. Histopathologic analysis of explanted livers was performed to document tumor cell death and measure Bcl-2 levels (inhibitor of apoptosis).

RESULTS

Diffusion-weighted MR imaging delineated zones of tumor cell death as regions of lower signal intensity in both groups. Apparent diffusion coefficients were significantly greater in the area of tumor necrosis than in the area of viable tumor. Histologic analysis demonstrated a significantly lower percentage of viable cells in the treated group (<1%) than in the control group (55%). Bcl-2 expression detected within the viable areas of the tumor was greater in the treated group than in the control group.

CONCLUSIONS

Chemoembolization causes extensive tumor cell destruction. Diffusion MR imaging can detect tumor cell death and can be used to assess the efficacy of chemoembolization. Bcl-2 was expressed in the treated group, suggesting an apoptotic pathway of cell death.

A novel glutamine-rich putative transcriptional adaptor protein (TIG-1), preferentially expressed in placental and bone-marrow tissues

We used a subtractive hybridization protocol to identify novel expressed sequence tags (ESTs) corresponding to mRNAs whose expression was induced upon exposure of the human leukemia cell line K562 to the phorbol ester 12-O-tetradecanolyphorbol-13-acetate (TPA). The complete open reading frame of one of the novel ESTs, named TIG-1, was obtained by screening K562 cell and placental cDNA libraries. The deduced open reading frame of the TIG-1 cDNA encodes for a glutamine repeat-rich protein with a predicted molecular weight of 63kDa. The predicted open reading frame also contains a consensus bipartite nuclear localization signal, though no specific DNA-binding domain is found. The corresponding TIG-1 mRNA is ubiquitously expressed. Placental tissue expresses the TIG-1 mRNA 200 times more than the lowest expressing tissues such as kidney and lung. There is also preferential TIG-1 mRNA expression in cells of bone-marrow lineage.In-vitro transcription/translation of the TIG-1 cDNA yielded a polypeptide with an apparent molecular weight of 97kDa. Using polyclonal antibodies obtained from a rabbit immunized with the carboxy-terminal portion of bacterially expressed TIG-1 protein, a polypeptide with molecular weight of 97kDa was identified by Western blot analyses of protein lysates obtained from K562 cells. Cotransfection assays of K562 cells, using a GAL4-TIG-1 fusion gene and GAL4 operator-CAT, indicate that the TIG-1 protein may have transcriptional regulatory activity when tethered to DNA. We hypothesize that this novel glutamine-rich protein participates in a protein complex that regulates gene transcription. It has been demonstrated by Naar et al. (Naar, A.M., Beaurang, P.A., Zhou, S., Abraham, S., Solomon, W.B., Tjian, R., 1999, Composite co-activator ARC mediates chromatin-directed transcriptional activation. Nature 398, 828-830) that the amino acid sequences of peptide fragments obtained from a polypeptide found in a complex of proteins that alters chromatin structure (ARC) are identical to portions of the deduced open reading frame of TIG-1 mRNA.

Neuro-Behçet's disease

Behçet's disease (BD) is a multifocal disorder with an immunogenetic basis, which persists over many years. Initial descriptions mentioned oral and genital ulcers with uveitis. Later a number of other manifestations were added, like skin, joint and neurological. The involvement of nervous system (Neuro-Behçet's) is reportedly uncommon. We hereby report four cases of Neuro-Behçet's, i.e.; two cases of strokes involving multiple areas of the central nervous system and two cases had features of benign intracranial hypertension. All cases had mucocutaneous lesions or other system involvement. Cases satisfied the international study group criteria for diagnosis of BD. All cases were pathergy test positive. In comparison with the literature from Turkey and Greece, which reports a high pathergy positivity, reports from India have shown only few cases to be positive. The prognosis of Neuro-Behçet used to be poor but has recently been improved with reduced mortality, although whether this can be attributed to treatment with steroids and/or cytotoxic agents remains uncertain.

Contraception: a new practical learning package

BACKGROUND

A new self-directed learning package was developed to assist medical students learn the counselling and practical skills to enable them to communicate with men and women about contraception and related matters.

OBJECTIVES

This paper describes the package and the way it was facilitated, the students' ratings of the package and their feedback about the session on the first time it was presented at four teaching hospitals.

RESULTS

The students rated the contraception package as average. The reasons given were: no introduction to the contraception session, lack of a trained person to conduct and facilitate the contraception learning session, poor organization at one of the hospitals and too little emphasis on self-assessment. The assumption that the students had a basic hormonal knowledge prior to the contraception sessions was incorrect.

DISCUSSION

The results suggest the contraception learning package needs a person with contraceptive knowledge, patient-doctor skills and experience with self-directed learning to be present throughout the 3-hour session and for tools to be available that emphasize self-assessment during the session.

OUTCOME

The modifications to be made to the learning package include pairing male and female students, a reduction in duration of the learning stations, an additional learning station relating to hormonal contraception, and inclusion of pregnancy and ovulation testing. These modifications were suggested by the participating students.

Transradial coronary stent placement in a patient with severe idiopathic autoimmune thrombocytopenic purpura

A 62-year-old man with refractory, idiopathic, autoimmune thrombocytopenic purpura developed unstable angina. Despite a platelet count of 3,000, transradial cardiac catheterization and coronary stent placement in the left anterior descending coronary artery were successfully performed. The patient was treated with clopidogrel for two weeks and aspirin for four weeks without adverse event.

Improving the body image, eating attitudes, and behaviors of young male and female adolescents: a new educational approach that focuses on self-esteem

OBJECTIVE

This study examines the effect of an interactive, school-based, self-esteem education program on the body image and eating attitudes and behaviors of young male and female adolescents following the program and after 12 months.

METHOD

All 470 eligible students (63% female) aged 11-14 years volunteered to participate. The intervention group students participated in the program, whereas the control group students received their scheduled personal development and health class.

RESULTS

The program significantly improved the body satisfaction of the intervention students and significantly changed aspects of their self-esteem; social acceptance, physical appearance, and athletic ability became less important for the intervention students and more important for control students. Female intervention students rated their physical appearance as perceived by others significantly higher than control students and allowed their body weight to increase appropriately by preventing the age increase in weight-losing behaviors of the control students. One year after the intervention, body image and attitude changes were still present. These findings also held for the 116 students (63% females) with low self-esteem and higher anxiety, who were considered at risk for the development of eating disorders. These students also had significantly lower drive for thinness and greater body satisfaction following the intervention and the decreased importance of physical appearance to their self-esteem was present at 12 months. Control at-risk students significantly decreased their body weight, whereas the weight of the intervention at-risk students significantly increased. The intervention program was effective, safe, having no effect on measures of students' anxiety or depression, and was rated highly by students.

DISCUSSION

This is the first controlled educational intervention to successfully improve body image and to produce long-term changes in the attitudes and self-image of young adolescents. This new approach to prevent the development of eating disorders by improving self-esteem may be effective, particularly if reinforced by teachers and family.

Gross morphology and ultrastructure of dendritic cells in the normal human decidua

Five normal placentae of normal pregnancy and delivery were used to study the gross morphology and ultrastructure of the dendritic cells in the normal human decidua. Zinc iodide osmium (ZIO) mixture was prepared. Small pieces of the placenta were processed for light microscopy and electron microscopy. For light microscopy, the small pieces of placenta were incubated in 20 mM PBS-EDTA solution, ph 7.4 at 37 degrees C to detach the basal plate. The basal plate pieces were incubated in ZIO. A wholemount preparation of the basal plate demonstrated the whole profile and gross morphology of the dendritic cell. For electron microscopy, the placenta pieces were fixed in 3% glutaraldehyde in 0.1 M phosphate buffer, ph 7.4, washed with phosphate buffer, put in ZIO mixture, washed in distilled water, dehydrated in graded ethanol, cleared in propylene oxide, and embedded in resin. Ultra thin sections of the ZIO blocks were cut using a diamond knife and stained with lead citrate. Ultrastructure of the dendritic cell presented multiple cytoplasmic processes, lobulated or round or oval, heterochromatic or euchromatic nucleus, mitochondria, free ribosomes, and pieces of rough endoplasmic reticulum, but no Birbeck granules.

Ischaemia selectivity confers efficacy for suppression of ischaemia-induced arrhythmias in rats

Eight novel and three reference antiarrhythmics were investigated in anaesthetised rats for antiarrhythmic actions, as well as for effects on the electrocardiogram (ECG) under normal and "simulated ischaemic" conditions. In rats subjected to coronary artery occlusion lidocaine, (+/-)-trans-[2-(4-morpholinyl)-cyclohexyl]naphthyl-1-acetate, RSD1000 and (+/-)-trans-[2-(4-morpholinyl)-cyclohexyl]-2-(1-naphthyl)propionate, RSD1030, (Group A) produced dose-related and complete antiarrhythmic protection. Group B compounds, such as (+/-)-trans-N-methyl-N-[2-(1-pyrrolidinyl)-cyclohexyl]-3, 4-dichlorocinnamamide, RSD995, produced complete antiarrhythmic protection but had aberrant dose-response curves. Group C compounds, such as quinidine and flecainide, failed to give full antiarrhythmic protection and had shallow dose-response curves. The potency of Group A compounds, but not Group B or C compounds, for ECG actions indicative of Na(+) channel blockade (prolongation of PR and QRS intervals) were significantly increased under "simulated ischaemic" conditions ([K(+)] 10 mM and pH 6.4) in isolated rat hearts. Thus, compounds with ischaemia-selective actions provided superior protection against ischaemia-induced arrhythmias in rats.

Onset of disordered eating attitudes and behaviors in early adolescence: interplay of pubertal status, gender, weight, and age

The interplay of puberty, gender, weight, and age in regard to body image and disordered eating behaviors and attitudes was investigated in a sample of early adolescents. It was found that, after menarche, females had increased personal expectations and were dissatisfied with weight/shape changes. They wanted to reduce their weight and between-meal eating (which was associated with increased feelings of inadequacy, loss of control, and decreased self-esteem). Young postmenarcheal females who were higher achievers and had higher trait anxiety were more likely to have lower weight. Young males at puberty desired to build up their bodies, believing that appearance was important to their sexual appeal. They were also more willing to form close relationships. Postpubertal males felt most in control of their lives, had the highest self-esteem, and were more trusting of their body cues. Overall, high achieving, more anxious postmenarcheal females were at greatest risk for eating disturbances. These results indicate that the interaction of pubertal status and gender must be considered when developing intervention programs.

Effects of prolonged ACTH-stimulation on adrenocortical accumulation of lipofuscin granules in aged rats

Subcellular deposition of lipofuscin granules is a marker of aging. Human and rodent adrenal cortices accumulate lipofuscin granules with age, but the mechanism that leads to the accumulation is not known. The ultrastructural appearance of lipofuscin granules resembles that of secondary lysosomes. Since adrenocortical subcellular events are predominantly influenced by ACTH action, we therefore studied the effect of prolonged ACTH-stimulation on adrenocortical accumulation of secondary lysosome-like granules, designated herein as lipofuscin granules. Using aged Fischer 344 male rats as a model, we found that a 7 day ACTH stimulation exerts a reducing effect on adrenocortical lipofuscin accumulation. Thus, adrenocortical accumulation of lipofuscin granules with age in vivo may not be an irreversible process.

Significance of simultaneous determination of serum and seminal plasma alpha-tocopherol and retinol in infertile men by high-performance liquid chromatography

High-performance liquid chromatography was used for the simultaneous determination of alpha-tocopherol and retinol in serum and semen of 40 subfertile men. The serum levels of the two vitamins were significantly higher in serum than in semen (3- to 10-fold) (P < 0.001). The mean alpha-tocopherol levels were higher in the serum and semen of men with normal sperm parameters (20 +/- 5 and 5 +/- 4 mumol L-1) than those with oligozoospermia (10 +/- 4 and 3 +/- 2 mumol L-1), azoospermia (8 +/- 3 and 3 +/- 1 mumol L-1) and asthenozoospermia (9 +/- 6 and 3 +/- 2 mumol L-1) (P < 0.002). Mean retinol levels in serum were similar in men with normal sperm parameters (2.4 +/- 2 mumol L-1) as in those with defective sperm parameters such as oligozoospermia (2.5 +/- 2 mumol L-) and asthenozoospermia (2.1 +/- 1.0 mumol L-) (P = 0.15), but significantly lower in men with azoospermia (1.3 +/- 0.3 mumol L-1) (P < 0.05). The alpha-tocopherol:retinol ratio was significantly higher in semen than in serum of men with normal sperm parameters (11.5) and those with asthenozoospermia (10.3) compared with ratios in those with oligozoospermia (8.3) and azoospermia (6.3). This may be related to reduced antioxidant activity in sperm dysfunction as a result of lipid peroxidation, from increased generation of reactive oxygen species.

Melanoma in the gastrointestinal tract

OBJECTIVE

This article focuses on the clinical, diagnostic, and therapeutic aspects of malignant melanoma metastases to the gastrointestinal (GI) tract. The subject of primary malignant melanoma arising from the GI tract is also discussed. Malignant melanoma is the most common tumor metastatic to the GI tract, and can present with fairly non-specific symptoms.

METHODS

Up to 60% of patients with melanoma are found to have metastases at autopsy. Frequent GI sites of invasion include the small bowel (50%), colon (31.3%), and anorectum (25%), seen in our institution over the past 9 yr. Malignant melanoma is a frequent source of metastases to the gastrointestinal (GI) tract.

RESULTS

Herein we report the case of a melanoma masquerading as a rectal polyp. We have also discovered 16 cases of melanoma metastases to the GI tract, at our institution, over the past 9 yr. The most frequent sites included small bowel (50%), colon (31.3%), and anorectum (25%).

CONCLUSION

Despite innocuous gastrointestinal symptoms, metastatic melanoma should be a diagnostic consideration in any patient with a history of melanoma.

Prolonged hypoxic stress increases adrenal cholesterol reserve in rats without causing adrenal hypertrophy

1. It is known that, in rats, hypoxia stimulates adrenal steroidogenesis, but our understanding of the hypoxic effect on the glandular parameters remains incomplete. 2. Adrenals were collected and analysed from rats that had been exposed to hypoxic conditions for 3 weeks. 3. The results reveal increased adrenal concentrations of corticosterone, free cholesterol and total cholesterol without a change in glandular weight and protein concentration. The increased total cholesterol is primarily associated with enriched cholesteryl adrenate (CE22: 4), cholesteryl arachidonate (CE20: 4) and cholesteryl oleate (CE18: 1).