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Although GH deficiency may underlie the increased cardiovascular risk in adult hypopituitarism, other coexisting hormonal deficiencies and/or unphysiological hormone replacement may contribute. l-Deamino-8-d-arginine (DDAVP), when administered parenterally, potentiates hemostasis by increasing plasma procoagulant factors. We investigated whether chronic intranasal DDAVP therapy influences clotting factors (plasma fibrinogen, factor VIII, and von Willebrand factor antigen) and endothelial function (flow-mediated dilation of the brachial artery) in 30 GH-treated hypopituitary subjects, including both DDAVP-treated subjects (group A) (mean age, 46 ± 11 yr) and vasopressin-sufficient subjects (group B) (mean age, 47 ± 16 yr). Fifteen healthy controls (group C) (mean age, 48 ± 12 yr) were also studied. All hypopituitary patients were receiving stable GH replacement (median duration, 19 months). Comparing the three groups, concentrations of fibrinogen (mean ± sd) (A, 3.3 ± 1.0 g/liter vs. B, 3.5 ± 0.9 vs. C, 2.6 ± 0.8, P < 0.05), factor VIII (A, 130% ± 30% vs. B, 128% ± 30% vs. C, 104% ± 35%, P < 0.05) and von Willebrand factor antigen (A, 124% ± 35% vs. B, 134% ± 45% vs. C, 93% ± 36%, P < 0.05) were higher in hypopituitary subjects, compared with controls. However, there were no differences in clotting factors between groups A and B. Flow-mediated dilation did not differ significantly between the two hypopituitary groups (A, 5.9% ± 2.0% vs. B, 4.7% ± 1.6%) and was similar to that in the control group (C, 5.7% ± 2.1%). In conclusion, although endothelium-dependent vasodilation is intact in GH-treated hypopituitary adults, elevated concentrations of hemostatic markers suggest the persistence of a prothrombotic tendency and endothelial dysfunction. Intranasal DDAVP does not appear to influence this proatherogenic profile in hypopituitary adults with vasopressin deficiency.

The purpose of this study was to evaluate critical power (W(CP)) as an indicator of aerobic fitness in trained cyclists, and to determine its relationship to cycling time trial (TT) performance. Thirteen competitive USCF category 2 or 3 cyclists provided season's best 40 km TT times (mean [SD]) time = 59.6 min (3.1), and performed two 17 km TT under controlled conditions (26.6 min [1.1]). Ventilatory threshold (VT) and VO2max were determined from a maximal incremental test. W(CP) was calculated using the results of four all-out constant power tests. Mean W(CP) was 299 (61) W or 4.1 W x kg(-1), VT was 3616 (750) ml x min(-1) or 49.8 ml x kg(-1) x min(-1) (7.5), and VO2max was 4596 ml x min(-1) or 63.5 ml x kg(-1) x min(-1) (8.0). W(CP) was strongly related to VT and VO2max, demonstrating that it can serve as a measure of aerobic fitness in this population. Expressions of W(CP) were slightly to considerably more highly related to 17 km and 40 km TT performances (r = -0.77 to -0.91) than were expressions of VT and VO2max (r = -0.71 to -0.87). It is concluded that W(CP) provides an aerobic fitness measure for competitive cyclists which can be obtained without invasive testing. In addition, W(CP) is strongly related to the TT performance of competitive cyclists.

The scientific community has recently focused its concerns on possible developmental delays in infants exposed to methylmercury via maternal fish consumption. In this study, the authors reported levels of methylmercury in hair specimens that corresponded to 2820 monthly seafood consumption diaries recorded by U.S. women of childbearing age. In this study, the geometric mean hair methylmercury level for diarists who reported some seafood consumption was 0.36 ppm (one geometric standard deviation [GSD] range = 0.14-0.90 ppm); the corresponding value for diarists who reported no seafood consumption was 0.24 ppm (one GSD range = 0.09-0.62 ppm). Therefore, the mean hair methylmercury level associated with seafood consumption was 0.12 ppm (one GSD range = 0.05-0.32 ppm). The results of this study provide evidence that levels of methylmercury in the U.S. population are quite low. There is a significant contribution to hair methylmercury from sources other than seafood. It is not likely that maternal hair methylmercury levels in the range found in our study would be associated with adverse health effects in children.

Facial cooling (FC) elicits a marked bradycardia at rest that appears to be reduced during exercise. This study was done to delineate the effects of exercise mediated central command from those of muscle afferent feedback and sympathetic stimulation on the attenuation of the bradycardic effect of FC during the onset of exercise. Ten healthy subjects (26 +/- 2 yr) were exposed to FC under five different conditions: 1) seated rest on the cycle ergometer, 2) onset of mild exercise (resting HR + 20 beats.min-1), 3) onset of moderate exercise (resting HR + 50 beats.min-1), 4) seated rest on the ergometer during electrical stimulation, and 5) seated rest on the ergometer during a cold immersion test (CT) (one hand immersed in an ice slurry at 0 degree C). The two exercise intensities were presumed to provide different degrees of central command. Electrical stimulation of the quadriceps was assumed to provide isolated muscle afferent feedback, while the CT served as a sympathetic stimulus. Beat-by-beat data were recorded for HR and mean arterial blood pressure for the duration of each test (50 s), and a rating of perceived pain was taken after each FC. FC elicited significant increases in mean arterial pressure during mild and moderate exercise compared with resting control (P0.05) and during moderate exercise compared to exercise without FC (P0.05). Mean decreases in HR during FC were similar for resting control (-12 +/- 3 beats.min-1), electrical stimulation (-10 +/- 3 beats.min-1), and CT (-9 +/- 3 beats.min-1). The HR response to FC during mild exercise (-7 +/- 2 beats.min-1) was significantly different (P0.05) from the rest condition; however, there was no significant bradycardia (-2 +/- 2 beats.min-1; P0.05) during onset of moderate exercise. These findings suggest that the magnitude of cold face-induced bradycardia may be attenuated at exercise onset by neural signals related to the higher levels of central motor command associated with heavier exercise.

Although two thirds or more of patients with microprolactinoma achieve normal serum prolactin levels over the long term after withdrawal of dopamine agonist therapy, there is no agreement on the appropriate duration of treatment, and treatment is not always interrupted. In this retrospective analysis of 89 patients, 84 women and 5 men with a mean age of 33 years, remissions were analyzed in 67 patients treated with 0.5 to 3 mg cabergoline weekly and 22 others given 2.5 to 10 mg bromocriptine daily. The mean duration of therapy was 3.1 years, and patients were followed for at least 1 year after treatment ended. None of the patients received medication other than a dopamine agonist. Seven women discontinued treatment when they became pregnant. All patients were symptomatic and hyperprolactinemic when first seen. Among 57 patients (64%) who had a recurrence after treatment stopped were 46 (81%) who had recurrent symptomatic hyperprolactinemia within 12 months after stopping treatment. The average interval was 9.6 months. Thirty-two patients, 36% of the total, achieved remission after at least 1 year of follow up; the mean duration of remission was 3.6 years. Nearly 85% of these patients remained in remission for longer than 2 years. Four of them were asymptomatic despite being hyperprolactinemic. The 2 dopamine agonists were equally effective. The overall median duration before relapse after discontinuance of treatment was 12 months. Logistic regression analysis failed to demonstrate an association between the risk of recurrence and age at presentation, imaging of an adenoma, or the duration of treatment. When dopamine agonist therapy is abruptly withdrawn after 2 years or longer in patients with microprolactinoma, 30% to 40% achieve long-term remission without side effects. Because symptomatic hyperprolactinemia may develop more than 1 year after treatment stops, long-term follow up is essential.

With the introduction of interventional procedures such as percutaneous mitral valvuloplasty and radiofrequency ablation of left-sided bypass tracts, there has been renewed interest in the technique of transseptal left heart catheterization. We review our experience with 1,279 transseptal catheterizations performed over the last 10 years. The most common indications for transseptal catheterization included direct measurement of left atrial pressure or access to the left ventricle in patients with prosthetic aortic or mitral valves, and in patients undergoing percutaneous mitral valvuloplasty. A total of 17 major complications occurred (1.3%), including cardiac tamponade (15 patients, 1.2%), systemic emboli (1 patient, 0.08%), and death secondary to aortic perforation (0.08%). We conclude that when performed by experienced operators, transseptal left heart catheterization is associated with low morbidity and mortality.

A newly available carotenoid food-composition database providing specific carotenoid values for > 2300 foods was linked to dietary data on 57 male nonsmokers to examine the association between dietary carotenoid intake and plasma carotenoid concentrations over 3 wk when free-living. Carotenoid intake was estimated from a food-frequency questionnaire (FFQ) and 7 d of food diaries with concurrent analysis of plasma carotenoid concentrations. After adjustment for energy intake, percentage of energy from alcohol, and plasma lipid concentrations, significant diet-plasma correlations for the FFQ and the food diaries (FD) included alpha-carotene (r = 0.29 and 0.43), beta-carotene (r = 0.36 FFQ only), beta-cryptoxanthin (r = 0.46 and 0.44), lutein (r = 0.44 FD only), and lycopene (r = 0.53 FD only). Dietary carotenoid intakes were associated with plasma carotenoid concentrations for all the carotenoids except for beta-carotene when food diaries were used whereas the diet-plasma correlation for the provitamin A carotenoids were consistently significant when the FFQ was used.

Three studies were performed to evaluate the effects of jet lag on factors associated with sport performance. In Study 1, members of the USA Women's Soccer Team traveled to Taiwan; in Study 2, North American students and faculty traveled to Western Europe; and in Study 3, European students traveled to North America. After travel, there was disruption of mood state and a reduction in dynamic strength; peak 5-s power and 30-s work capacity were reduced for 2 days (5-s power: 9.8 vs. 9.0 vs. 9.0 W∙kg−1; 30-s work capacity: 213 vs. 199 vs. 201 J∙kg−1). In these studies, mood state, anaerobic power and capacity, and dynamic strength were affected by rapid transmeridianal travel, and even highly trained athletes suffered from jet lag. However, effects of travel on the variables tested were essentially eliminated after 3 or 4 days. Key words: circadian rhythm, anaerobic power, anaerobic capacity, mood, travel

ABSTRACI’ We determined serial changes in four major plasma carotenoid fractions (a-carotene, /3-carotene, lutein/ zeaxanthin, and lycopene) in 30 men consuming defined daily doses of carotenoids from foods (broccoli, carrots, or tomato juice) or from purified /3-carotene in capsules (12 or 30 mg) for 6 wk while fed a controlled diet. Compared with baseline, /3carotene increased in the 30- and 12-mg-capsule and carrot groups whereas a-carotene increased in the carrot group and lutein increased in the broccoli group. Lower lutein concentrations in recipients of/3-carotene capsules suggested an interaction between these two carotenoids. Lycopene declined in all groups except the tomato-juice group. Total carotenoid concentration changes only reflected the large increases in /3-carotene concentrations and not the smaller changes observed in other individual carotenoids. Overall, purified /3-carotene produced a greater plasma response than did similar quantities ofcarotenoids from foods sources. However, some foods increased plasma concentrations of certain carotenoids. Am J C/in Nutr l992;55

In the 1950s, Puerto Rico began an active industrialization program. We used data from the 1982 Puerto Rico Fertility and Family Planning Assessment to describe the trend in the incidence of breastfeeding in Puerto Rico over time and to ascertain some of its determinants. From 1946 through 1982, 5,884 infants were born among this statistically representative sample of reproductive-aged women. The proportion of infants who had ever been breastfed was 59 percent for births before 1960 (mean duration = 7.8 months), dropped to 25 percent for infants born from 1970 to 1974 (mean duration = 4.9), and rose to 38 percent for births delivered from 1980 to 1982 (mean duration = 3.4). Prior breastfeeding experience was an important determinant of breastfeeding a newborn. Infants of mothers who had breastfed a previous baby were 7.3 times more likely to be breastfed (95% confidence interval = 6.6, 8.0) compared with infants of mothers who had not previously breastfed. The 38 percent of infants who were breastfed in Puerto Rico in the early 1980s is below the 74 percent to 97 percent reported in Latin America and below the 54 percent reported in the United States for the same period. This study provides baseline data for any future intervention strategies.

Alström syndrome (AS) is a rare autosomal recessive condition characterized by retinal degeneration, childhood obesity, and severe insulin resistance. Dilated cardiomyopathy of unknown aetiology is a well-recognized and potentially lethal complication. The aim of this study was to investigate the relationship between vascular function, hyperinsulinaemia and cardiac performance in AS.Fifteen subjects with AS (mean age 21 years, range 10-35) were studied and compared with age-, sex-, and blood pressure-matched healthy controls. Large artery stiffness and wave reflections were assessed in both groups by measuring aortic and brachial pulse wave velocity (PWV) (carotid-femoral and carotid-radial) and augmentation index (AIX) (Sphygmocor). In AS subjects, left ventricular function was assessed by echocardiography and metabolic parameters including fasting insulin, glucose, lipids and brain natriuretic peptide were also measured.Comparing AS subjects vs. controls (mean +/- SD), AIX was elevated in AS subjects (18 +/- 9% vs. 3 +/- 11%, P0.0001). No significant changes in brachial PWV (8.1 +/- 1.3 m s(-1) vs. 7.3 +/- 1.1 m s(-1), P = 0.14) or aortic PWV (6.5 +/- 1.1 m s(-1) vs. 6.0 +/- 1.0 m s(-1), P = 0.26) were observed. AS subjects were hyperinsulinaemic and had disturbances in lipid profiles relative to controls. No correlations were observed between vascular, metabolic and echocardiographic parameters.In AS there are alterations in the shape of the central arterial pressure waveform associated with augmented aortic systolic pressure and indicative of increased wave reflection. Unfavourable central arterial haemodynamics in AS may contribute to the development of cardiomyopathy but other aetiological factors are probably involved.

Background Anabolic androgenic steroids are used by some bodybuilders to enhance performance. While the cardiovascular implications of supraphysiological androgen levels requires further clarification, use is associated with sudden death, left ventricular hypertrophy, thrombo-embolism and cerebro-vascular events. Materials and methods To further understand the effect of androgenic anabolic steroid abuse on vascular function, this study assessed vascular stiffness (pulse-wave analysis) and cardiovascular risk factors in 28 male, bodybuilding subjects, of whom ten were actively receiving anabolic agents (group A; 26·4 ± 7·2 years) and eight had undergone a 3-month ‘wash-out’ period (group B; 32·1 ± 7·1 years). The remaining ten bodybuilding subjects (group C; 24·4 ± 4·4 years) denied any past use of anabolic steroids or other performance enhancing drugs. Comparisons were made with ten sedentary male controls (group D, 29·3 ± 4·7 years). Results Endothelial independent dilatation in response to glycerol trinitrate was significantly impaired in the group currently using anabolic steroids (group A) compared with the other three groups [A (5·63 ± 3·24%) versus; B (11·10 ± 4·91%), C (17·88 ± 9·2%) and D (14·46 ± 3·9%), P < 0·0005, respectively], whereas no significant differences in endothelial-dependant dilatation were detected between the groups [A (5·0 ± 3·0%), B (7·4 ± 3·4%), C (9·6 ± 4·5%) and D (8·2 ± 3·3%), P < 0·059, respectively]. Conclusions Previous studies described a decline in vascular reactivity occurring in bodybuilding subjects which is independent of anabolic steroid use and may result from smooth muscle hypertrophy with increased vascular stiffness. This study revealed impaired vascular reactivity associated with anabolic agents and that improvement in vascular function may occur following their discontinuation.

Insulin therapy may influence cardiovascular disease (CVD) and lipid metabolism in type 2 diabetes (T2D). Exaggerated postprandial lipaemia (PPL) is a feature of diabetic dyslipidaemia affecting CVD via enhanced oxidative stress (OS) and endothelial dysfunction. We assessed endothelial function and OS during PPL following insulin and vitamin C. Twenty (17 M) T2D patients were studied (mean Hba1c 8.4%) at baseline, following 6 weeks of insulin lispro (0.2 Iu kg-1) and vitamin C 1-g daily. Eight-h lipid and glucose profiles were measured following a fatty meal. Endothelial function (flow-mediated vasodilatation: FMD) and OS were measured at fasting, 4 h and 8 h.Glucose, body mass index, and total and LDL cholesterol remained unchanged. FMD improved. Placebo group: fasting, 1.1 +/- 1.2 to 4.2 +/- 1.1% (P0.001); 4-h, 0.3 +/- 1.2 to 3.1 +/- 0.9% (P0.01); 8-h, 0.7 +/- 1.1 to 3.76 +/- 1.1% (P0.001). Vitamin C group: fasting, 0.9 +/- 1.1 to 6.1 +/- 1.3% (P0.001); 4-h, 0.7 +/- 1.5 to 4.9 +/- 2.1% (P0.001); 8-h, 0.8 +/- 0.9 to 5.8 +/- 0.6% (P0.01). Post-prandial lipaemia was attenuated: TG area-under-curve (mmol L-1 8 h-1), 52.6 +/- 11 to 39.1 +/- 12.5 (placebo group), P0.02; and 56.9 +/- 8 to 40.1 +/- 10.3 (vitamin C group), P0.02. Oxidative stress was reduced, with greater changes in the vitamin C group.Insulin may thus exert vascular benefits in T2D, by modifying fasting and postprandial lipid metabolism resulting in reduced OS and improved EF. Vitamin C therapy may augment the vascular benefits of insulin in T2D through additional effects on OS and EF.

Hypothyroidism is associated with cardiovascular dysfunction. It is increasingly apparent that stiffening of central arteries may lead to increased afterload and cardiac dysfunction. We noninvasively studied the peripheral and central pressure waveforms in 12 untreated hypothyroid patients as well as in 12 age-, sex-, and body mass index-matched controls using the technique of pulse wave analysis from recordings at the radial artery. Indexes of arterial stiffness, augmentation index (AI) and augmentation of central arterial pressure (AG), were derived as well as time of travel of the reflected wave (TR), a direct estimate of aortic pulse wave velocity. At baseline, there were no significant differences between the 2 groups in brachial and aortic blood pressures. Hypothyroid patients had significantly higher AI than controls (mean +/- SEM[SCAP], 32.0 +/- 3.4% vs. 17.0 +/- 2.4%; P0.0005) even when corrected for heart rate (AI(C); 28.0 +/- 3.2% vs. 17.0 +/- 2.4%; P0.006) and AG (13.0 +/- 2.2 vs. 7.0 +/- 2.1 mm Hg; P0.03) together with a lower TR (132.0 +/- 4.1 vs. 142.0 +/- 1.5 msec; P0.03). After 6 months of therapy with T(4), all patients were euthyroid. AI(C) had decreased in the patient group (23.0 +/- 3.2% vs. 28.0 +/- 3.2%; P0.01) as had AG (9.0 +/- 1.5 vs. 13.0 +/- 2.2 mm Hg; P0.008), but TR was significantly higher (142.0 +/- 3.0 vs. 132.0 +/- 4.1 msec; P0.008). AI correlated with age in all groups (hypothyroid group: r = 0.937; P0.0005; control group: r = 0.804; P0.0005), but correlated with TSH level only among controls (r = 0.591; P0.05). This study confirms that hypothyroidism is associated with increased cardiovascular risk, as evidenced by increased augmentation of central aortic pressures and central arterial stiffness. Furthermore, these abnormalities are reversed after adequate T(4) replacement.

Nine men (25.11 +/- 1.16 years) performed 3 different test sessions. In the control session, subjects performed a 10-second sprint cycle test and 1 repetition maximum (1RM) in the back squat. The 5-minute test session consisted of 10 x 1 repetition in the parallel back squat exercise at 90% of their 1RM, 5 minutes of rest, and then a 10-second sprint cycle test. The 20-minute test session consisted of the same test protocol as the 5-minute test session except that the subjects rested for 20-minutes prior to the sprint cycle test. Significant differences were found in average power and average power relative to body weight (F = 5.684, p = 0.014, and F = 1.258, p = 0.006, respectively) for the 5-minute test session. The authors conclude that this particular squat protocol could have a potential carry-over effect into improvements in 100-m sprint times when performing the squats 5-minutes prior to performance.

The primary objective was to estimate prevalence of malnutrition on admission to four hospitals. Secondary objectives included assessing the relationship between nutritional status and length of hospital stay, numbers of new prescriptions, new infections and disease severity.We entered eligible patients according to predefined quotas for elective and emergency admissions to 23 specialties. We measured height, weight, Body Mass Index and anthropometrics, and recorded history of unintentional weight loss. Patients who had lostor = 10% of their body weight, had a Body Mass Index20, or had a Body Mass Index20 with one anthropometric measurement15th centile were considered malnourished.Of 1611 eligible patients, 761 did not participate; 269 were too ill; 256 could not be weighed; and 236 refused consent. Eight hundred and fifty were subsequently evaluated. Prevalence of malnutrition on admission was 20%. Length of stay, new prescriptions and infections and disease severity were significantly higher in the malnourished.One patient in every five admitted to hospital is malnourished. Although this figure is unacceptably high, it may underestimate true prevalence. Malnutrition was associated with increased length of stay, new prescriptions and infections. Malnutrition may also have contributed to disease severity.

To analyze the presentation, evaluation, and treatment of a subset of patients with well-differentiated thyroid carcinoma who present with a lateral neck mass and no palpable disease in the thyroid gland.A retrospective review of all patients undergoing thyroidectomy for malignancy.A database of all thyroidectomies performed for malignancy by the Vanderbilt University Department of Otolaryngology-Head and Neck Surgery from 1992 to 1997 was created. Patients who presented with an isolated neck mass without evidence of palpable disease in the thyroid were selected for the study population.There were 60 cases of thyroid malignancy, with 14 cases (23.3%) that presented as isolated lateral neck mass. The characteristics of this group (compared with the population of all thyroid malignancies) include younger age at presentation (37.7 +/- 15.2 y vs. 49.8 +/- 15.6 y; Student t test: P = .019) and long-standing presence of symptoms (27.4 +/- 39.6 mo vs. 3.6 +/- 3.9 mo; P = .023). These patients generally presented from a referring facility after having an excisional biopsy, which was 100% accurate. Fine-needle aspiration is becoming more useful and was 66.7% accurate. Histological examination revealed cancer in the thyroid gland in all patients, 11 cases of papillary carcinoma, 2 follicular carcinomas, and one medullary carcinoma The mean size of the primary focus was 10.9 +/- 8.7 mm, with 29% demonstrating bilateral disease and 14% demonstrating multifocal disease in the ipsilateral gland. The neck specimens revealed an average of 5.3 +/- 3.2 metastatic nodes in levels II-IV and 3.9 +/- 4.6 metastatic nodes in the paratracheal region.Based on this patient population, the long-standing lateral neck mass in the young patient should raise the physician's index of suspicion for thyroid carcinoma Fine-needle aspiration should be used in conjunction with judicious excisional biopsy. The bilateral and multifocal nature of otherwise occult primary disease argues for total thyroidectomy in this setting.

Cushing’s syndrome is a heterogeneous disorder characterized by numerous physical, psychological and metabolic abnormalities associated with glucocorticoid excess. Left untreated, the condition is associated with considerable morbidity and mortality. 1 The importance of accurate diagnosis and treatment can be inferred from the improved outcome following intervention. However, some individuals do not conform to traditional investigative approaches, presenting a diagnostic trap for the unwary. During the last

A 39-year-old man presented with lower limb muscle pains and weakness which had progressed rapidly over the preceding 2 weeks. Immediately prior to hospital admission he was unable to stand unaided. There had been no disturbance of bulbar, sensory or sphincter function and he reported no recent gastrointestinal symptoms. Medical history included colitis, which was quiescent. His only regular medication was olsalazine. On examination, he was normotensive (and remained so throughout his admission). There was no rash. Cardiovascular, respiratory and abdominal examinations were normal. Neurological examination revealed generalised weakness in all four limbs, most marked proximally. Tendon reflexes were preserved. Plantar response was flexor. Examination of cranial nerves was normal. Laboratory investigations revealed a serum potassium of 1.8 mmol/l. Serum sodium, urea and creatinine were within normal limits. Creatine kinase was 10 719 IU/l. A quadriceps muscle biopsy was performed and the histology is shown in figure 1. Further investigations included an abdominal ultrasound scan, following which computed tomography (CT) of the abdomen was performed (figure 2). A 24-hour urine collection for catecholamines was undertaken (table). View this table: Table Levels of free …

We describe four pregnancies in two families in which mild hypophosphatasia, apparently transmitted as an autosomal dominant trait, manifested in utero as severe long bone bowing. Postnatally, there was spontaneous improvement of the skeletal defects. Recognition of this presentation for hypophosphatasia by family investigation and assessment of the fetal skeleton for degree of ossification and chest size using ultrasonography is important. The prognosis for this condition is considerably better than for more severe forms of hypophosphatasia and for many other disorders that cause skeletal defects with long bone bowing in utero.

Although the physiological underpinnings of critical power (CP) have yet to be fully elucidated, it has been proposed that CP demarcates the heavy and severe exercise intensity domains and that each domain is associated with a different pattern of metabolic response and mechanism of fatigue. Severe intensity has been defined such that, during exercise at intensities above CP, the slow component of the [Formula: see text] response will drive [Formula: see text] to [Formula: see text] at the point of fatigue. In this Study, two parameters were derived for each of 8 participants: (a) CP, the asymptote of the relationship between power and time to exhaustion, and (b) a related parameter, CP′, the asymptote of the relationship between power and time to [Formula: see text] CP′ theoretically represents the threshold intensity above which [Formula: see text] will be elicited during exercise of sufficient duration. Participants performed two exhaustive tests at CP. There were three important findings: First, there was a practice effect on time to exhaustion at CP, and times increased 27% in the second test. Second, both CP and CP′ could be obtained with good precision. Third, and most important, CP was equal to CP′, thereby providing a physiological description of the mathematically derived CP parameter. It was concluded that [Formula: see text] cannot be elicited at intensities equal to or less than CP. Key words: cycle ergometry, endurance, exercise

Cobb's collar or Moormann's ring is a stricture of the bulbar urethra which is largely unrecognised but has considerable relevance urologically as the site of congenital or post-instrumental strictures. The history, anatomy, embryology and surgical importance are reported.

Since 1990 (i.e., the year in which the number of abortions was highest), the annual number of abortions in the United States has decreased by 15%.This report summarizes and reviews information reported to CDC regarding legal induced abortions obtained in the United States during 1995.For each year since 1969, CDC has compiled abortion data received from 52 reporting areas: 50 states, the District of Columbia, and New York City.In 1995, a total of 1,210,883 legal abortions were reported to CDC, representing a 4.5% decrease from the number reported for 1994. The abortion ratio was 311 legal induced abortions per 1,000 live births, and the abortion rate was 20 per 1,000 women aged 15-44 years, the lowest ratio and rate recorded since 1975. Women who were undergoing an abortion were more likely to be young, white, and unmarried; most were obtaining an abortion for the first time. Approximately half of all abortions (54%) were performed ator =8 weeks of gestation, and approximately 88% were performed before 13 weeks. Approximately 16% of abortions were performed at the earliest weeks of gestation (or =6 weeks), approximately 17% at 7 weeks of gestation, and approximately 21% at 8 weeks of gestation. Few abortions were provided after 15 weeks of gestation -- approximately 4% of abortions were obtained at 16-20 weeks, and 1.4% were obtained ator =21 weeks. Younger women (i.e., women agedor =24 years) were more likely to obtain abortions later in pregnancy than were older women.Since 1990, the number of abortions has declined each year. Since 1987, the abortion-to-live-birth ratio has declined; in 1995, it was the lowest recorded since 1975. This decrease in the abortion ratio reflects a trend that a lower proportion of pregnant women obtain induced abortion.The number and characteristics of women who obtain abortions in the United States should continue to be monitored so that trends in induced abortion can be assessed, efforts to prevent unintended pregnancy can be evaluated, and the preventable causes of morbidity and mortality associated with abortions can be identified and reduced.

The Healthy People 2000: National Health Promotion and Disease Prevention Objectives specifies goals of no more than 3.3 maternal deaths per 100,000 live births overall and no more than 5.0 maternal deaths per 100,000 live births among black women; as of 1990, these goals had not been met. In addition, race-specific differences between black women and white women persist in the risk for pregnancy-related death.This report summarizes surveillance data for pregnancy-related deaths in the United States for 1987-1990.The National Pregnancy Mortality Surveillance System was initiated in 1988 by CDC in collaboration with the CDC/American College of Obstetricians and Gynecologists Maternal Mortality Study Group. Health departments in the 50 states, the District of Columbia, and New York City provided CDC with copies of death certificates and available linked outcome records (i.e., birth certificates or fetal death records) of all identified pregnancy-related deaths.During 1987-1990, 1,459 deaths were determined to be pregnancy-related. The overall pregnancy-related mortality ratio was 9.2 deaths per 100,000 live births. The pregnancy-related mortality ratio for black women was consistently higher than for white women for every risk factor examined by race. The disparity between pregnancy-related mortality ratios for black women and white women increased from 3.4 times greater in 1987 to 4.1 times greater in 1990. Older women, particularly women agedor =35 years, were at increased risk for pregnancy-related death. The gestational age-adjusted risk for pregnancy-related death was 7.7 times higher for women who received no prenatal care than for women who received "adequate" prenatal care. The distribution of the causes of death differed depending on the pregnancy outcome; for women who died following a live birth (i.e., 55% of the deaths), the leading causes of death were pregnancy-induced hypertension complications, pulmonary embolism, and hemorrhage.Pregnancy-related mortality ratios for black women continued, as noted in previously published surveillance reports, to be three to four times higher than those for white women. The risk factors evaluated in this analysis confirmed the disparity in pregnancy-related mortality between white women and black women, but the reason(s) for this difference could not be determined from the available information.Continued surveillance and additional studies should be conducted to assess the magnitude of pregnancy-related mortality, to identify those differences that contribute to the continuing race-specific disparity in pregnancy-related mortality, and to provide information that policy makers can use to develop effective strategies to prevent pregnancy-related mortality for all women.

From 1991 through 1994, the number of legal induced abortions reported to CDC declined each year byor =5% from the number reported for the preceding year.This report summarizes and reviews information reported to CDC regarding legal induced abortions obtained in the United States during 1993 and 1994. This analysis also includes recently reported abortion-related deaths that occurred during 1991.For each year since 1969, CDC has compiled abortion data received from 52 reporting areas: 50 states, the District of Columbia, and New York City.In 1993, 1,330,414 legal abortions were reported to CDC, representing a 2.1% decrease from the number reported for 1992; in 1994, 1,267,415 abortions were reported, representing a 4.7% decrease from the number for 1993. In 1993 and 1994, the abortion ratio was 334 and 321 legal induced abortions per 1,000 live births, respectively. In 1993, the abortion rate was 22 per 1,000 women aged 15-44 years; in 1994, this rate declined to 21 per 1,000 women. Women who were undergoing an abortion were more likely to be young, white, and unmarried; most were obtaining an abortion for the first time. More than half of all abortions (52%-54%) were performed ator =8 weeks of gestation, and approximately 88% were before 13 weeks. Approximately 15%-16% of abortions were performed ator =6 weeks of gestation, 16% were performed at 7 weeks, and 22% at 8 weeks. Younger women (i.e., women agedor =19 years) were more likely to obtain abortions later in pregnancy than were older women. In 1991, 12 women died as a result of induced abortion: 11 of these deaths were related to legal abortion and one to illegal abortion. During 1991, the case-fatality rate of legal induced abortion was 0.8 abortion-related deaths per 100,000 legal induced abortions.Since 1990, the number of abortions has declined each year. Since 1987, the abortion-to-live-birth ratio also has declined; in 1994, it was the lowest recorded since 1977. This decrease in the abortion ratio reflected the lower proportion of pregnant women who obtained an induced abortion. As in previous years, deaths related to legal induced abortions occurred rarely (i.e., approximately one death per 100,000 legal induced abortions).The number and characteristics of women who obtain abortions in the United States should continue to be monitored so that trends in induced abortion can be assessed, efforts to prevent unintended pregnancy can be evaluated, and the preventable causes of morbidity and mortality associated with abortions can be identified and reduced.

From 1980 through 1992, the number of legal induced abortions reported to the CDC remained stable, varying each year byor = 5%.This report summarizes and reviews information reported to CDC regarding legal induced abortions obtained in the United States during 1992. This report also includes recently reported abortion-related deaths for 1988-1991 and an update on abortion-related deaths for 1985-1987.For each year since 1969, CDC has compiled abortion data received from 52 reporting areas (i.e., the 50 states, the District of Columbia, and New York City).In 1992, 1,359,145 abortions were reported--a 2.1% decrease from 1991. The abortion ratio was 335 legal induced abortions per 1,000 live births, and the abortion rate was 23 per 1,000 women 15-44 years of age. Women who were undergoing an abortion were more likely to be young, white, and unmarried; most had had no previous live births and were obtaining an abortion for the first time. More than half (51%) of all abortions were performed at or before the 8th week of gestation, and 87% were before the 13th week. Approximately 14% of abortions were performed ator = 6 weeks of gestation, 15% were performed at 7 weeks of gestation, and 22% at 8 weeks of gestation. Younger women (i.e., womenor = 19 years of age) were more likely to obtain abortions later in pregnancy than were older women. Sixteen deaths in 1988, 12 deaths in 1989, and five deaths in 1990 were associated with legal induced abortion. The case-fatality rates for 1988, 1989, and 1990, respectively, were 1.2, 0.9, and 0.3 abortion-related deaths per 100,000 legal induced abortions.Since 1980, the number and rate of abortions have remained relatively stable, with only small year-to-year fluctuations ofor = 5%. However, since 1987, the abortion-to-live-birth ratio has declined; in 1992, the abortion ratio was the lowest recorded since 1977. More pregnant women have been opting to carry their pregnancies to term rather than choosing to have an abortion. As in previous years, deaths associated with legal induced abortions occurred rarely (i.e., one or fewer deaths per 100,000 legal induced abortions).The number and characteristics of women who obtain abortions in the United States should continue to be monitored so that efforts to prevent unintended pregnancy can be assessed and the preventable causes of morbidity and mortality associated with abortions can be identified and reduced.

Public health surveillance data describing family planning services at Title X clinics and characteristics of women receiving these services during 1991 are contained in this report. These data update previously published information concerning characteristics of women and services at such clinics during 1981.1991.Data characterizing patients and services were reported by family planning clinics to Title X grantees. These data for 1991 were provided by all 75 grantees to CDC's Family Planning Services Surveillance (FPSS) project.In 1991, 4.2 million women received services at Title X clinics. Overall, 69.5% of family planning patients had chosen oral contraceptives as their method of contraception, and 64.7% of patients were at or below the federal poverty level. In addition to information characterizing patients and services at Title X clinics, this report also evaluated current data-collection methods used by Title X grantees. Complexities in the analysis reflected variations in the quality and availability of data, including differences in definitions, data-collection instruments at the clinic level, and data categories.The number and characteristics of family planning patients receiving services at Title X clinics during 1991 were similar to the number and characteristics during 1981. Furthermore, these results underscore the need to improve the quality and timeliness of family planning data and to facilitate program planning and operations at the grantee level.These surveillance findings have been communicated to state family planning administrators and to national Title X program administrators. This information will be used to assess how publicly funded family planning clinics currently contribute to health-care delivery and how these clinics might contribute to a national system of reproductive health-care services in the future.

The purpose of this study was to evaluate the effect of pedal cadence methodology on the relationship between power output and time to exhaustion. Twenty-four subjects each performed 12 all-out cycle ergometer tests (four at a constant 60 rpm, four at a constant 100 rpm, and four where they were allowed to select and, within each test, vary their cadence). The parameters of the hyperbolic power-time relationship, AWC (anaerobic work capacity) and CP (critical power), were estimated for each pedal cadence methodology using three regression models: nonlinear power-time, linear work-time, and linear power-time-1. In all cases, R2 was high and standard errors of the estimate of AWC and CP were low. With the two constant rpm methodologies, the estimates of AWC and CP were influenced by the choice of regression model. The estimates of AWC and CP were also influenced by the pedal cadence in the all-out tests. For example, the CP derived from the 100 rpm tests (mean +/- SD: 195 +/- 50 W) was lower (p < 0.05) than the CP from the other methodologies (207 +/- 50 W and 204 +/- 48 W), and the AWC from the variable cadence methodology (16.1 +/- 6.2 kJ) was greater than the AWC from constant rpm trials (14.5 +/- 5.9 kJ and 14.6 +/- 5.7 kJ). It is concluded that pedal cadence methodology influences the parameters of the power-time relationship.

Maternal consumption during pregnancy of methylmercury (MeHg)-contaminated fish in Japan and of MeHg-contaminated bread in Iraq caused psychomotor retardation in the offspring. Studies in Iraq suggested adverse fetal effects when maternal hair mercury concentrations were as low as 20 ppm. This prospective study involved 131 infant-mother pairs in Mancora, Peru with peak maternal hair MeHg levels during pregnancy from 1.2 ppm to 30.0 ppm, geometric mean 8.3. The MeHg was believed to be derived from marine fish in the diet. There was no increase in the frequency of neurodevelopmental abnormalities in early childhood. The possible role of selenium or other protective mechanisms in marine fish is discussed. This previously unpublished study was conducted between 1981 and 1984. Our report of August 1985 to the funding agencies has been circulated, and the data were presented at the Twelfth International Neurotoxicology Conference in Hot Spring, Arkansas, October 30 to November 2, 1994. The current account has not been modified or updated since 1985. For reference to interim publications on fetal MeHg studies in Iraq and New Zealand see Marsh et al., 1995.

Estimates of anaerobic work capacity (AWC) were determined in 26 subjects using the critical power concept. AWC estimates were derived using three mathematically equivalent models: nonlinear power-time, linear power-1/time, and linear work-time. We hypothesized that large variability between estimates generated using the three models might reflect systematic error in the data and that large standard errors of estimate (SEE) might reflect random error. Therefore, subjects were grouped according to the variability in the three AWC estimates and according to the magnitude of the SEE of the parameter estimates. Then AWC estimates were compared to a criterion measure of anaerobic capacity, namely maximal oxygen deficit. When variability in the AWC estimates was low (10%), all provided accurate measures of oxygen deficit; also, when SEE were low, estimates were accurate. When variability was high, mean AWC estimates derived using linear models differed from oxygen deficit by over 15%; when SEE were high, mean AWC estimates derived using all models differed from oxygen deficit by over 10%. It is concluded that the accuracy of estimates of anaerobic capacity derived using the critical power concept can best be ensured by accepting values only when all three models provide the same value and/or when the SEE of the AWC estimate is small.

Since 1980, the number of legal induced abortions reported to CDC has remained fairly stable, varying each year byor = 5%.This report summarizes and reviews data received by CDC for legal induced abortions obtained in 1990.For each year, CDC compiles abortion data received from 52 reporting areas: 50 states, New York City, and the District of Columbia.In 1990, 1,429,577 abortions were reported--a 2.4% increase from 1989. The abortion ratio for 1990 was 345 legal induced abortions per 1,000 live births, and the abortion rate was 24 per 1,000 women ages 15-44 years. Most women undergoing abortions were young, white, and unmarried; most had had no previous live births and were having the procedure for the first time. Approximately half of all abortions were performed before the 8th week of gestation, and 87% were before the 13th week of gestation. Younger women were more likely to obtain abortions later in pregnancy than were older women.Since 1980, the national number (and rate) of abortions has remained relatively stable, with only small (or = 5%) year-to-year fluctuations. However, since 1984, the national abortion ratio has declined; in 1990, the abortion ratio was the lowest recorded since 1977. Increasing rates of childbearing may account for some of this decline.The number and characteristics of women having abortions are needed from all states to furnish an accurate characterization of legal induced abortion in the United States and to assist efforts to identify and reduce preventable causes of morbidity and mortality associated with abortions.

Summary— The mobile lithotriptor is a new method of providing extracorporeal shock wave lithotripsy (ESWL) directly to the smaller urological centres. The unit, containing a Dornier HM4 lithotriptor, has treated 135 patients with a total of 168 treatments in 2 centres in the Oxford region. The overall success rate was 87% with no serious morbidity or mortality. The results compare well with the results from larger centres and the system is cost-effective. We suggest that it is one of the best methods of providing ESWL to the smaller urological centres.

The purpose of this study was to evaluate effects of gender on anaerobic and aerobic contributions to high-intensity exercise. A group of 38 subjects (22 women, 16 men) performed modified Wingate tests against resistances of 0.086 kg kg-1 body mass (0.844 N kg-1) for women and 0.095 kg kg-1 body mass (0.932 N kg-1) for men. The aerobic contribution to total work performed was determined from breath-by-breath analyses of expired gases during each test. Total work in 30 s was 30% lower (Student's t test; P < 0.01) in women than men (211 +/- 5 J kg-1 versus 299 +/- 14 J kg-1). Aerobic contribution was only 7% lower (P = 0.12) in women than men (53 +/- 1 J kg-1 versus 57 +/- 2 J kg-1). The anaerobic component of the work performed, determined by subtraction of the aerobic component from total work in 30 s, was 35% lower (P < 0.01) in women than men (158 +/- 5 J kg-1 versus 242 +/- 15 J kg-1). It is concluded that, because women provide a relatively higher (P < 0.01) portion of the energy for a 30-s test aerobically than men (25% versus 20%), total work during a Wingate test actually underestimates the gender difference in anaerobic capacity between women and men.

Since 1980, the number of legal induced abortions reported to CDC has remained stable, varying each year by5%. In 1989, 1,396,658 abortions were reported--a 1.9% increase from 1988. The abortion ratio for 1989 was 346 legal induced abortions/1,000 live births, and the abortion rate was 24/1,000 women ages 15-44 years. The abortion ratio was highest for black women and women of other minority racial groups and for women15 years of age. Overall, women undergoing abortions tended to be young, white, and unmarried; to have had no previous live births; and to be having the procedure for the first time. Approximately half of all abortions were performed before the eighth week of gestation, and 87% were before the thirteenth week of gestation. Younger women tended to obtain abortions later in pregnancy than older women. This report also includes newly reported abortion-related deaths for 1986 and 1987, as well as an update on abortion-related deaths for the period 1978-1985. Ten deaths in 1986 and six deaths in 1987 were associated with legal induced abortion. The case-fatality rate in 1986 was 0.8 abortion-related deaths/100,000 legal induced abortions and 0.4/100,000 in 1987.

The prevalence of smoking in Puerto Rican women was estimated on the basis of data from 3,157 women 15 to 49 years of age who had been surveyed in the 1982 Evaluation of Fertility and Family Planning in Puerto Rico. The weighted prevalence was 15.5%, with a 95% confidence interval of 13.8 to 17.1. The prevalence varied by age group, education, marital status, place of residence at age 15, and consumption of alcohol. The prevalence of smoking increased in successive birth cohorts while the mean age at initiation of the habit tended to decline. The data suggest that in Puerto Rico smoking is on the rise among younger women.

Six men performed a total of 23 modified Wingate power tests against 5.5 kp (53.9 N) resistance on a Monark 864 ergometer. Breath-by-breath VO2 was measured using a SensorMedics 4400 metabolic cart. Peak anaerobic power (highest 5 s; mean(s.e.m.)) was 819(16) W (11.1(0.6) W kg-1) and anaerobic capacity (work in 30 s; mean(s.e.m.)) was 18.2(0.2) kJ (248(11) J kg-1). Contributions of ATP-PC, glycolytic and aerobic systems each 5 s were estimated. ATP-PC power (mean(s.e.m.)) peaked at 750(14) W (10.2(0.6) W kg-1) in the first 5 s; glycolytic power (mean(s.e.m.] peaked at 497(11) W (6.8(0.7) W kg-1) between 10 and 15 s into the test; aerobic power (mean(s.e.m.)) peaked at 157(5) W (2.1(0.3) W kg-1) during the last 5 s of the test, and VO2 exceeded 90% VO2peak Over the entire 30 s, aerobic contribution was 16%, glycolytic contribution was 56%, and ATP-PC contribution was 28%. It is concluded that glycolytic power peaks within the first 15 s of high power exercise; also, aerobic metabolism responds quickly during 'anaerobic' exercise and makes a significant contribution to the work performed.

Acquired immunodeficiency syndrome (AIDS) is globally fatal; before death, it often causes a multitude of medical complications leading to significant physical impairment and functional loss. Specifically, the neuropathology associated with AIDS can be diverse, and it ranges from inconsequential cerebrovascular insults to rapidly progressive neuronosis. Moreover, physical impairments may present any time during the course of the disease and even before knowledge of seropositivity. We present three patients infected with human immunodeficiency virus (HIV), each with a different form of neuropathology, who were treated by rehabilitative services and who gained reasonable functional benefits within moderate time periods. The growing number of HIV-infected persons with physical debilitation mandates a rational, knowledgeable approach to rehabilitation intervention. This article highlights the importance of a thorough understanding of the neurologic complications of AIDS in setting realistic goals and in improving the quality of life for these individuals.

To understand further the epidemiology and causes of maternal death, the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, reviewed all identified maternal deaths in the United States, including Puerto Rico, for the period from 1979 through 1986. The maternal mortality ratio for the period was 9.1 deaths/100,000 live births. The ratios increased with age and were higher among women of black and other minority races than among white women for all age groups, particularly for women ages greater than or equal to 40 years. Unmarried women had a higher risk of death than married women. Women who had received any prenatal care had a lower risk of dying than women who had received no care (RR = 0.19, 95% confidence limits (CL) 0.15, 0.23). Women who received no prenatal care had a gestational age-adjusted risk of maternal death 5.7 times that of women receiving care defined as "adequate." The risk of maternal death increased with decreasing levels of education for all age groups, particularly among women ages greater than or equal to 35 years. The causes of death varied for different outcomes of pregnancy; pulmonary embolism was the leading cause of death following the delivery of a live birth. Future studies aimed at developing strategies to reduce the risk of maternal deaths in the United States should use enhanced surveillance and collect more information about each death, which would allow for better understanding of factors associated with maternal mortality.

Since 1980, the number of legal abortions reported to CDC has remained fairly stable, varying each year by less than 3%. In 1988, 1,371,285 abortions were reported--a 1.3% increase from 1987. The abortion ratio for 1988 was 352 legally induced abortions/1,000 live births, and the abortion rate was 24/1,000 women ages 15-44 years. The abortion ratio was higher for black women and women of other minority races and for women less than 15 years of age. However, the abortion ratio for women less than 15 years was lower in 1988 than in any previous year since 1972. Women undergoing legally induced abortions tended 1) to be young, white, and unmarried, 2) to live in a metropolitan area, 3) to have had no previous live births, and 4) to be having the procedure for the first time. Approximately half of all abortions were performed before the eighth week of gestation, and greater than 85% were performed during the first trimester of pregnancy (less than 13 weeks of gestation). Black women and women of other minority races tended to obtain abortions later in pregnancy than did white women; however, age was a more dominant influence than race. Younger women tended to obtain abortions later than older women. Educational level strongly influenced when an abortion was performed; better educated women had an abortion earlier in gestation.

Anaerobic power and capacity were measured in nine college-age men at four different times of day: 03.00 h, 09.00 h, 15.00 h, and 21.00 h. Modified Wingate tests were performed against a common resistance of 5.5 kg (0.074 +/- 0.004 kg per kg body mass). Peak power was defined as the highest power output during a 5-s period in the test, and anaerobic capacity was defined as the total external work during the 30-s test. Peak power tended to differ across testing times (F = 2.50, p = .10), with the mean at 21.00 h about 8% higher (p less than .05) than at 03.00 h. Anaerobic capacity differed across the times of day (F = 9.58, p less than .01), with the means at 15.00 h and 21.00 h about 5% higher (p less than .05) than at 03.00 h and 09.00 h. These results suggest that there are circadian rhythms in anaerobic power and capacity.

To understand better the epidemiology and to describe the causes of maternal death, we reviewed all identified maternal deaths in the United States and Puerto Rico for 1979-1986. The overall maternal mortality ratio for the period was 9.1 deaths per 100,000 live births. The ratios increased with age and were higher among women of black and other minority races than among white women for all age groups. The causes of death varied for different outcomes of pregnancy; pulmonary embolism was the leading cause of death after a live birth. Unmarried women had a higher risk of death than married women. The risk of death increased with increasing live-birth order, except for primiparas. In order to develop strategies to reduce the risk of maternal death in the United States, future studies should include expanded information about each death, which will allow better understanding of factors associated with maternal mortality.

Since 1980, the number of legal abortions reported to CDC has remained fairly stable, varying each year by less than 3%. In 1986, 1,328,112 abortions were reported; in 1987, that number increased by approximately 2% to 1,353,671. The abortion ratio for 1986 was 354 legally induced abortions per 1,000 live births; the ratio for 1987 was 356 per 1,000. The national abortion rate was 23/1,000 females ages 15-44 years for 1986 and 24/1,000 females ages 15-44 years in 1987. Abortion ratios were higher among women of black and other minority races and among women less than 15 years of age. Women undergoing legally induced abortions tended 1) to be young, white, and unmarried, 2) to have had no previous live births, and 3) to be having the procedure for the first time. In 1987, approximately half of all abortions were performed before the eighth week of gestation, and greater than 85% were performed during the first trimester of pregnancy (less than 13 weeks of gestation).

Twenty-four male subjects originally participated in a study to determine the effects of feeding diets comparatively low in copper (1.03 mg/day/2850 kcal) and containing either 20% fructose or starch on indices of copper status. During the course of feeding the diets for 11 wk, four of the subjects exhibited heart-related abnormalities and were removed from the study. Fructose ingestion had no effect on serum ceruloplasmin activity or serum copper concentration but did significantly reduce cuprozinc superoxide dismutase (SOD) activity of erythrocytes as compared to starch. Repletion of the subjects with 3 mg copper/day for 3 wk significantly increased SOD levels in subjects previously fed fructose but not starch. Apparent copper balance was significantly greater when the subjects consumed the fructose as compared to the starch diet. These results suggest that the typeof dietary carbohydrate fed can differentially affect indices of copper status in humans. Am J C/in Nut,' l985;42:242-251.

Twenty eight adults, 12 men and 16 women, participated in a 1-yr study designed to assess daily nutrient intake accurately. All subjects lived at home, consumed self-chosen diets, and maintained a detailed daily dietary record throughout the year. During four 7-day balance studies, one in each season of the year, meals, beverages, urine, and feces were analyzed for sodium and potassium content by atomic absorption spectrometry. Total intakes averaged 3.4 g/day for sodium and 2.8 g/day for potassium. The Na:K ratio for all diets analyzed averaged 1.3. Nutrient densities of sodium and potassium were 1.8 and 1.5 g/1000 kcal, respectively. Apparent absorptions of sodium and potassium were 98 and 85%, respectively, and did not change significantly over the wide range of intakes. Average urinary excretions of sodium and potassium were 86 and 77% of total intake, respectively. Mean metabolic balances were positive for sodium, +0.47 g/day, and potassium, +0.28 g/day. The data of this study provide useful information concerning the dietary intakes, excretions, and balances of sodium and potassium for adults based on analytic determination.

Trophoblastic embolism is subclinical in normal pregnancy, pronounced in eclampsia, and massive in hydatidiform mole. Self-limited acute respiratory distress arises in 3% to 10% of molar pregnancies at the time of uterine evacuation. Infrequently death occurs; the principal findings are trophoblastic emboli in the pulmonary arterioles, edema of the lungs, and dilatation of the right side of the heart. Hyperthyroidism may develop, and fibrin may line the alveolar walls. Pathogenetic mechanisms include heart failure, hyperthyroidism, dilutional anemia, and pulmonary arteriolar blockage. Infusions of fluid and whole blood tend to cause pulmonary overload, which may precipitate right-sided heart failure. Preferred therapy consists of diuresis and ventilatory support, especially with oxygen under positive end-expiratory pressure.

A study population consisting of 66 mentally retarded individuals, 60 with and six without pica, was evaluated for iron status, and for plasma and hair zinc, copper, and magnesium levels within a month of known dietary intake. The parameters were all within the normal range for individuals without pica. In contrast, subjects practicing pica had low plasma zinc and elevated plasma copper values as compared to those without pica. Plasma magnesium was in the low normal range for all individuals in the study population. Among the indicators of iron status measured, Hb, hematocrit, plasma iron, total iron-binding capacity, iron saturation, and plasma ferritin, several values were low (p less than 0.001). Depression in plasma zinc level was related to the type and severity of the pica. In plasma, zinc was positively correlated with iron and negatively correlated with copper. No relationships were found between dietary intakes and plasma levels of these minerals. The data suggest that malabsorption of zinc and iron were associated with some types of pica although the individuals received adequate dietary intake of minerals. Zinc, copper, and magnesium concentrations in hair were within normal ranges. Hair was a less sensitive indicator than plasma of trace element status.