Bone geometry according to menstrual function in female endurance athletes

Athletes have higher bone mineral density (BMD) relative to nonathletes. In amenorrheic athletes BMD may be compromised by estrogen deficiency, but it is unknown whether this is accompanied by structural differences. We compared femoral neck bone geometry and density of a-/oligomenorrheic athletes (AAs), eumenorrheic athletes (EAs), and eumenorrheic controls (ECs). We recruited 156 women: (68 endurance athletes and 88 controls). Femoral neck BMD, section modulus (Z), and width were measured using dual-energy X-ray absorptiometry. Menstrual function was assessed by questionnaire and classified as EA (≥10 periods/year) or AA (≤9 periods/year): 24 athletes were AA and 44 EA. Femoral neck BMD was significantly higher in EA than AA (8 %, difference) and EC (11 % difference): mean [SE] 1.118 [0.015], 1.023 [0.020] and 0.999 [0.014] g cm(-2), respectively; p < 0.001. Z was significantly higher in EA than EC (11 % difference): EA 667 [19], AA 625 [21], and EC 592 [10] cm(3); p < 0.001. Femoral neck width did not differ between groups. All differences persisted after adjustment for height, age, and body mass. The higher femoral neck Z and BMD in athletes, despite similar width, may indicate that exercise-related bone gains are endosteal rather than periosteal. Athletes with amenorrhea had smaller increments in bone mass rather than structural adaptation. The maintained femoral neck width in controls may be an adaptive mechanism to conserve bone strength in bending despite inactivity-related bone decrement.

Levels of histamine and histamine-producing bacteria in smoked fish from New Zealand markets

Smoked fish has been the most commonly implicated product in presumptive cases of scombroid poisoning in New Zealand. One hundred seven samples of smoked fish were purchased from Auckland retail markets between July 1995 and March 1996, and their histamine and bacterial levels were determined. Eight samples, obtained from five of the nine retail outlets sampled, had histamine levels which exceeded 50 mg/kg, the level set by the FDA as an indicator of decomposition. Histamine levels in only 2 samples (346.4 and 681.8 mg/kg) exceeded a hazard level of 200 mg/kg. Thirty-three of the smoked fish were held at 20 degrees C for 2 days, and 8 of these developed histamine levels above 50 mg/kg with 4 exceeding 200 mg/kg (maximum 1,659.4 mg/kg). The stored samples that exceeded 200 mg/kg were all obtained from two outlets. Within or between fish species there were no consistent relationships between levels of histamine in the samples and either the total aerobic plate counts or the numbers of histamine-producing bacteria. To the contrary, there was evidence that histamine had been formed prior to smoking and that histamine-producing bacteria were eliminated during smoking.

Ocular cosmesis in retinopathy of prematurity. The Cryotherapy for Retinopathy of Prematurity Cooperative Group

We report the externally apparent outcome in the natural history cohort (n = 4099) that was followed up prospectively in the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity. The overall incidence of an adverse cosmetic outcome in the survivors who were examined 12 months post term (n = 2759) was 15.1%. Adverse cosmetic outcomes included strabismus (12.8%), nystagmus (3.3%), total retrolental membrane (1%), epiphora (0.6%), corneal opacity (0.6%), cataract (0.3%), and episcleral hyperemia (0.3%). A comparable subgroup examined 24 months post term showed strabismus (14.4%), nystagmus (2.2%), epiphora (0.5%), corneal opacity (0.7%), cataract (0.5%), episcleral hyperemia (0.5%), lid fissure asymmetry (2.4%), and corneal diameter asymmetry (2.0%). The rate of adverse aesthetic outcome was greatest in eyes that had developed more severe acute retinopathy of prematurity and an unfavorable structural outcome. In patients with bilateral threshold retinopathy of prematurity who underwent no therapeutic ocular procedures, other than randomized assignment to undergo cryotherapy in one eye, more frequent adverse cosmetic outcomes were found in the untreated eyes.

Surgical approach to the obese patient

Morbid obesity is a life-threatening disorder associated with medical and psychological complications. The failure of medical therapy has led to the development of a new surgical discipline called bariatric surgery, which has evolved over the past three decades. Initial techniques created malabsorption to produce weight loss. Due to complications, later techniques limited oral intake to produce weight loss. Currently, most bariatric surgeons perform either gastric bypass or gastric partition (vertical banded gastroplasty or vertical ring gastroplasty). However, other techniques are also being evaluated, including a modified intestinal bypass, gastric banding, and a new gastric balloon. Only with continued follow-up will we determine the ultimate risk/benefit ratio of these procedures and their place in the management of the morbidly obese. In the setting of an experienced multidisciplinary team committed to long-term follow-up, surgical therapy can be considered.

The clinical and hemodynamic presentation of the shock patient

It is the nurse's responsibility to assess the critically ill patient and to interpret data so that therapy can be directed to optimally treat that individual. Shock is a complex progressive syndrome that includes specific types, such as cardiogenic, septic, anaphylactic, and hypovolemic. Clinical and hemodynamic parameters provide clues to the specific type of shock and its clinical progress. The progression of the shock state must be monitored by critical care nurses who are knowledgeable of and proficient in clinical assessment skills and the acquisition and interpretation of significant hemodynamic data.

A request for antenatal advice

An informed older woman in her first pregnancy often has greater than usual anxieties about the well-being of her baby. She is likely to seek advice about how to have a healthy pregnancy and which antenatal tests to have. Giving the correct guidance, however, is not so straightforward.