Search

This is the final report of the American Academy of Audiology Task Force on the Health-Related Quality of Life (HRQoL) Benefits of Amplification in Adults. A systematic review with meta-analysis examined evidence pertaining to the use of hearing aids for improving HRQoL for adults with sensorineural hearing loss (SNHL). Relevant search strings applied to the CENTRAL, CINAHL, Cochrane Reviews, ComDisDome, EBMR, and PubMed databases identified randomized controlled trial, quasi-experimental, and nonexperimental pre-post test designed studies. Sixteen studies met a priori criteria for inclusion in this review. A random-effects meta-analysis showed differential results for generic versus disease-specific HRQoL measures for within- and between-subject designs. Although generic measures used for within-subject designs did not demonstrate HRQoL benefits from hearing aids, mean effect sizes and confidence intervals for within-subject designs and disease-specific instruments suggested that hearing aids have a small-to-medium impact on HRQoL. Further, the between-subject studies supported at least a small effect for generic measures, and when measured by disease-specific instruments, hearing aids had medium-to-large effects on adults' HRQoL. This review concludes that hearing aids improve adults' HRQoL by reducing psychological, social, and emotional effects of SNHL. Future studies should include control groups using randomized controlled trials. [ABSTRACT FROM AUTHOR]

People constantly compare their appearance and well-being to that of other individuals. However, a measure of social comparison of well-being is lacking and existing appearance-related social comparison assessment is limited to comparison tendency using predefined social situations. This limits our understanding of the role of social comparison in appearance and well-being. Therefore, we developed the Scale for Social Comparison of Appearance (SSC-A) and the Scale for Social Comparison of Well-Being (SSC-W) to assess upward and downward social comparisons with regard to (a) frequency, (b) perceived discrepancy to the standard, and (c) engendered affective impact during the last 3 weeks. In one longitudinal and three cross-sectional studies ( N s = 500-1,121), we administered the SSC-A or SSC-W alongside measures of appearance social comparison, body satisfaction, self-concept, social rank, well-being, envy, rumination, depression, and anxiety. Confirmatory factor analyses supported the expected two-factor model representing upward and downward social comparison for both scales. Overall, upward comparison displayed the anticipated associations with the measured constructs, whereas downward comparison showed mostly small or nonsignificant correlations with the validators. The SSC-A and SSC-W are efficient measures of social comparison for appearance and well-being with good evidence for their reliability and validity in our samples.

A calcaneal tuberosity avulsion fracture occurring simultaneously with a rupture of the Achilles tendon, although occurring through similar mechanisms, is a rare injury pattern to see in combination and presents a unique challenge to the surgeon. The patient we present was initially found to have a type II fracture of the calcaneal tuberosity. However, during surgical fixation of the fracture, a complete rupture of the Achilles tendon was noticed. The technique used in this case was the fixation of the fracture fragment with two 5 mm fully threaded screws. The tendon was then reattached to the calcaneus using two Mitek anchors (DePuy Mitek Inc., MA, USA) with a modified Bunnell technique. There are a number of techniques suggested in the literature, including, among others, K-wires (DePuy Mitek Inc., MA, USA) and screw fixation. Our patient recovered well and has now been discharged from further orthopaedic follow-up., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, McCarthy et al.)

Abstract: Dental caries affect 97% of the world's population during their lifetime. Early childhood caries are the number one chronic disease affecting young children, and it disproportionately affects children of low-income families. American Academy of Pediatrics recommends fluoridated toothpaste to all children starting at tooth eruption, regardless of caries risk. In addition, fluoride varnish is recommended in all children every 3 to 6 months from tooth emergence until they have an established dental home. The health disparities that are most apparent in the rural communities are inadequate prenatal care, low birth weight, cancer, chronic respiratory disease, heart disease, unintentional injury, and stroke. When it comes to oral health, water fluoridation is one of the most cost-effective strategies in preventing dental caries. The need for oral health education in physician assistant/associate (PA) programs is well documented. Implementation has largely been performed using interprofessional education. This article describes an interprofessional education program that teaches PA students to apply fluoride varnish so that they are practice-ready when they graduate and practice medicine., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 PA Education Association.)

We introduce a novel approach to assess habitual comparison processes, while distinguishing between different types of comparison standards. Several comparison theories (e.g., social) suggest that self-evaluations use different standards to inform self-perception and are associated with wellbeing and personality. We developed the Comparison Standards Scale for Appearance (CSS-A) to examine self-reported engagement with social, temporal, criteria-based, dimensional, and counterfactual comparisons for upward and downward standards in relation to appearance. The scale was completed by three hundred participants online alongside measures of appearance schemas, social comparison evaluations, depression, anxiety, stress, self-esteem, physical self-concept, narcissism, and perfectionism. The CSS-A was found to reliably assess individual differences in upward and downward comparison frequency and affective impact for multiple comparison standards. In line with theory, CSS-A upward comparisons were more frequent than downward comparisons and coincided with negative (versus positive) affective impact. Comparison intensity (i.e., comparison frequency × discrepancy) predicted negative and positive affective impact for upward and downward comparisons, respectively. This relationship was partially mediated by appearance concern for upward comparisons (a composite of appearance schemas and physical self-concept), yet moderated by negativity for downward comparisons (a composite of depression, anxiety, stress, and self-esteem). We offer a framework for measuring the comparison process that warrants further research on underlying comparison processes, for which the CSS(-A) and experience sampling methods should serve as useful tools., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 McCarthy et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Plain film abdominal radiographs (PFAs) are frequently the initial investigation ordered for patients with abdominal symptoms. However, increasing use of emergency ultrasound and availability of emergency CT raises the question of whether PFA remains an appropriate first line investigation. We investigated the impact of out of hours (OOH) PFAs on inpatient management., Methods: All consecutive PFAs over an 8-week period were included to determine the impact on patient management. OOH was classified as from 5pm to 9am Monday to Friday, weekends and bank-holidays. PACS and hospital records were accessed to determine patient pathways. The institution is a tertiary referral centre with 850 acute beds and serves a population of 950,000., Results: A total of 758 consecutive PFAs were performed in total (58.3% male, mean age 58.1 (range 0-93)). 310 (40.9%) were requested from the emergency department (ED) and 382 (50.4%) were requested from wards. 160 (21.1%) met the criteria of OOH, of these 120 (72.2%) were from ED and 28 were on adult inpatients. Of these 28, none had a change in management based on the PFA result., Conclusion: Our study suggests that OOH PFAs of inpatients are of limited clinical utility. These patients are exposed to extra radiation., Implications for Practice: We propose that OOH PFAs of inpatients should be questioned as a viable investigation due to the limited contribution they offer in managing patients, the deleterious effects they confer on the patient and the associated economic cost. Further studies are needed to assess if these results are generalizable to other large hospitals., (Copyright © 2020 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Research has highlighted the role of social comparison processes in varying affect and psychological wellbeing. These processes can provide greater insight into cognitions and behaviours related to depression and anxiety disorders. This review aimed to examine the relationship of social comparison with depression and anxiety in clinically relevant samples, using a process-based approach. Studies of clinical and subclinical populations that utilized observational or experimental social comparison assessment were considered for review. A systematic literature search in Medline and PsycInfo databases produced 54 relevant studies (49 studies on adults and five on child and adolescent populations), 14 of which were suitable for a meta-analysis. A meta-analysis of the association of social comparison evaluation with depression and anxiety in clinical populations revealed weighted correlations of -0.53 and - 0.39, respectively. No subclinical studies were included in a meta-analysis due to a lack of comparable outcomes. Evidence suggests differences between depression and anxiety disorders in information seeking, where frequency and diversity of social comparisons vary; however, studies comparing disorders are lacking. Heterogeneity of experimental studies precluded inclusion in a meta-analysis. A narrative review of experimental data indicated depression and anxiety status is related to reactions to upward comparisons in the domains of affect and behaviour, where individual differences in evaluation can determine affective reactions and how comparison information is further sought. This review suggests social comparison has a significant association with depression and anxiety. However, the limited number of studies with clinical populations necessitates further research on social comparison processes in clinical samples., (© 2020 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.)

Objective: Due to an insidious proliferative pattern, invasive lobular breast cancer (ILC) often fails to form a defined radiological or palpable lesion and accurate diagnosis remains challenging. This study aimed to determine the value of preoperative magnetic resonance imaging (MRI) for ILC and its impact on surgical outcomes., Methods: Consecutive symptomatic patients diagnosed with ILC in a tertiary centre over a 9-year period were reviewed. The time from diagnosis until surgery, initial type of surgery/index operation (breast-conserving surgery [BCS]/mastectomy) and the rates of reoperation (re-excision/completion mastectomy) were recorded. Patients were grouped into those who received conventional imaging and preoperative MRI (MR+) and those who received conventional imaging alone (MR-)., Results: There were 218 cases of ILC, and 32.1% (n = 70) had preoperative MRI. Time from diagnosis to surgery was longer in the MR+ than the MR- group (32.5 vs 21.1 days, P  < .001) even when adjusting for age and breast density. Initial BCS was performed on 71.4% (n = 50) of MR+ patients and 72.3% (n = 107) of the MR- group. While the rate of completion mastectomy following initial BCS was higher in the MR+ group (30.0%, n = 15 vs 14.0%, n = 15; χ 2  = 5.63; P  = .018), this association was not maintained in multivariable analysis. No difference was recorded in overall (initial and completion) mastectomy rate between the MR+ and MR- group (50.0%, n = 35 vs 37.8%, n = 56; χ 2  = 2.89; P  = .089). Margin re-excision following BCS was comparable between groups (8.0%, n =4, vs 9.3%, n = 10; χ 2  = 0.076, P  = .783) despite the selection bias for borderline conservable cases in the MR+ group. The rate of usage of MRI for ILC cases declined over the study period., Conclusion: While MRI was associated with minor delays in treatment and did not reduce overall rates of margin re-excision or completion mastectomy, it altered the choice of surgical procedure in almost a quarter of MR+ cases. The benefit of preoperative breast MRI appears to be confined to select (younger, dense breast, borderline conservable) cases in symptomatic ILC., Competing Interests: Declaration of Conflicting Interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Deep vein thrombosis (DVT) is a condition classically associated with blood stasis, hypercoagulability or injury to the vasculature. As blood stasis is usually associated with patient immobility, DVT occurrence in young active patients with no underlying haematological conditions is a rarity. An exostosis, also known as osteochondroma, is a cartilage capped lesion. If solitary, they represent low malignant potential and unless symptomatic, they are rarely excised. A 23-year-old, active male, presented to hospital with pain and swelling in the left lower leg. It was a deep, non-radiating pain, exacerbated by exercise. Wells' criteria score for DVT was 2. An ultrasound was performed which identified thrombosis in the superficial femoral, and popliteal veins. Haematological causes of thrombosis were ruled out. X-ray showed a posterior femoral exostosis. It was determined that compression by the exostosis was the cause of the thrombosis. We present a case of a DVT secondary to osteochondroma formation in a young male. Isolated DVT in this setting is uncommon with fewer than five previously reported cases identified in the literature. We also discuss the current literature and management of this rare entity.

Rationale and Objectives: Deriving maximum benefit from radiology rotations in medical schools is challenging. Lack of education on appropriate imaging renders students feeling unprepared. This study compares the ability of undergraduate medical students to identify appropriate radiological investigations, both at the beginning and end of their final year of education, to those of residents in their first year of clinical practice., Materials and Methods: Twelve scenarios were extracted from the American College of Radiology's Appropriateness Criteria (ACR-AC) and a questionnaire was generated. One topic was selected from each of the 10 sections in the diagnostic section and two from the interventional section. The questionnaire was distributed to three groups. Group A was composed of medical students at the beginning of final year. Group B was composed of medical students at the end of final year. Group C was composed of residents at the end of their first year of clinical practice. Radiology residents were surveyed to assess familiarity with the ACR-AC among trainees in Ireland., Results: The total cohort included 160 participants. Group C (n = 35) performed significantly better than group A (n = 72) and group B (n = 53). There was no statistical difference in the mean scores achieved by group A and group B. Sixteen (73%) of 22 radiology trainees were familiar with the ACR-AC., Conclusions: A minimal improvement in the knowledge of medical students in requesting radiological investigations over the course of the final medical year, yet a significant impact of a relatively short period of "on-the-job" learning in the clinical setting, was indicated. Emphasis on education on appropriateness may offer an improvement in the utilization of radiology services and improve patient care., (Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Laparoscopic cholecystectomy (LC) is now considered the gold standard treatment for symptomatic gallbladder disease. Over the last two decades, a reduction in postoperative morbidity, mortality and hospital stay have seen a complete shift from open surgery to a laparoscopic approach. Intrahepatic subcapsular haematoma (ISH) is a rare and potentially life-threatening complication of LC. A 34-year-old female underwent LC for uncomplicated cholelithiasis. No complications were observed intra-operatively. 2 h postoperatively, the patient developed severe abdominal pain and tachycardia. Ultrasonography demonstrated an echogenic collection adjacent to the gallbladder fossa. Laparoscopy showed an ISH involving the right and left lobes of the liver, and no evidence of any intra-abdominal haemorrhage. Subsequent urgent triphasic CT identified a large ISH and a hypervascular lesion on the right lobe of the liver. This lesion demonstrated delayed enhancement with contrast filling suggestive of a hepatic haemangioma. This case report demonstrates the impact of imaging on postoperative management and the importance of postoperative patient monitoring in patients who have undergone laparoscopic surgery. Imaging explorations have a decisive role in the detection and characterization of haematomas.

To assess the level of achievement of current trainees, we investigated the academic qualifications, publication rates and future research plans of 240 radiology trainees in the UK and Ireland. All radiology trainees in the UK and Ireland were surveyed by a questionnaire enquiring about academic record and career ambitions. Our study shows that the level of academic achievement of radiology trainees is high, and provides interesting information concerning the current group of radiology trainees in these regions. It will be of interest both to radiology trainers and to doctors hoping to pursue a career in radiology. It also demonstrates that a potential recruitment crisis in academic radiology exists.

We herein present a regional review of the management of renal trauma in the west of Ireland. The majority of renal injuries occur as a result of blunt trauma and are amenable to conservative management. We sought to streamline the management of renal trauma in the west of Ireland. With the current restructuring of the Irish Health Service, it is important to acknowledge the role of the urologist in the management of trauma patients.

Background: Solitary adenomas have been shown to be responsible for almost 90% of cases of primary hyperparathyroidism., Aim: The purpose of this study was to determine the utility of sestamibi scanning pre-operatively to guide minimally invasive video-assisted (MIVA) parathyroidectomy., Methods: We reviewed 40 patients who underwent parathyroidectomy between 2003 and 2004. All patients underwent a pre-operative sestamibi scan., Results: Thirty-three (82%) patients had a localized solitary adenoma on sestamibi scan. Of these patients 29 underwent attempted MIVA parathyroidectomy. MIVA parathyroidectomy was successful in 22 patients. When pre-operative sestamibi scanning was correlated with pathological diagnosis it was shown to have a sensitivity of 82% and positive predictive value of 94%., Conclusion: Pre-operative sestamibi scan localization of a parathyroid adenoma offers a 94% positive predictive value for adenoma location. This facilitates MIVA parathyroidectomy to be used effectively to treat primary hyperparathyroidism in the majority of patients.

Objective: To test if functional electrical stimulation (FES) can enhance the recovery of upper extremity function during early stroke rehabilitation., Methods: Open-label block-randomized trial, begun during inpatient rehabilitation and continued at the patients' home. Patients were assigned to either FES combined with task-specific upper extremity rehabilitation (n = 7) or a control group that received task-specific therapy alone (n = 8) over 12 weeks. Outcome measures . Hand function (Box & Blocks, B & B; Jebsen-Taylor light object lift, J-T) and motor control (modified Fugl-Meyer, mF-M) were video-recorded for both upper extremities at baseline, 4, 8, and 12 weeks., Results: B&B mean score at 12 weeks favored (P = .049) the FES group (42.3 +/- 16.6 blocks) over the control group (26.3 +/- 11.0 blocks). The FES group J-T task was 6.7 +/- 2.9 seconds and faster (P = .049) than the 11.8 +/- 5.4 seconds of the control group. Mean mF-M score of the FES group at 12 weeks was 49.3 +/- 5.1 points out of 54, compared to the control group that scored 40.6 +/- 8.2 points (P = .042). All patients regained hand function., Conclusion: Upper extremity task-oriented training that begins soon after stroke that incorporates FES may improve upper extremity functional use in patients with mild/moderate paresis more than task-oriented training without FES.

Evaluation of gastric wall pathology using cross-sectional imaging has proved difficult, particularly in the imaging of early, localized disease. The properties of Calogen as a negative oral contrast agent for the evaluation of the upper gastro-intestinal tract and retroperitoneum in CT has been well described. We assess the suitability of this agent as an oral contrast medium for use in MRI examination of the gastric wall, finding the mean scores for Calogen and water with regard to gastric distension to be 8.46 and 5.49, respectively (P < 0.01). Concerning obliteration of mucosal detail, the respective scores are 8.48 and 3.84 (P < 0.01). Calogen is also statistically superior to water with regard to prevention of peristalsis and homogeneity (mean scores 8.15 vs. 5.74 and 8.69 vs. 6.30, respectively). Oral Calogen, therefore, is superior to water as an oral contrast agent for MRI examination of the gastric wall. Its ingestion allows identification of the gastric wall with fat intensity material on both sides, further aiding characterisation of subtle mural anomalies.

Aim: To assess the efficacy of polyethylene glycol solution as an oral contrast agent in a patient population., Material and Methods: Patients were fasted from 12.00 am. Administration of the oral contrast medium commenced 15 min before imaging and comprised one sachet of Norgine (Klean-prep, Middlesex, UK) reconstituted in 1 l water of which the patient took between 500-750 ml. Norgine is a balanced mixture of polyethylene glycol and electrolytes, which when added to water produces a clear colourless, iso-osmotic solution., Results: In total 38 candidates were identified retrospectively covering a 2-year period. Visualization of the jejunum, ileal loops and ileocaecal region was excellent or sufficient in 87, 95 and 89%, respectively. The time taken to obtain complete visualization of the small bowel, from the jejunum to the ileocecal region varied from 15-240 min with an average time of 65 min and 73.7% of patients necessitating delayed imaging., Conclusions: Polyethylene glycol was demonstrated to be an excellent oral contrast medium in distending the small bowel. However, small bowel transit times were significantly delayed and problematic necessitating repeated imaging within the patient population. As result of theses findings longer examination time should be expected within a patient population and this should be borne in mind when scheduling patients.

Alport syndrome, a hereditary nephritis accompanied by high-tone sensorineural deafness and distinctive ocular signs was first noted in the literature during the early 1900s. This disease is caused by a genetic defect in Type IV collagen which makes up basement membranes in many body systems. The patient will usually have bilateral anterior lenticonus causing varied refractive errors. You may also note yellow-white to silver flecks within the macular and midperipheral regions of the retina. The treatment of the visual problems is an important but secondary concern due to the seriousness of the systemic disease. Dual sensory loss, however, creates an urgent need for appropriate vision care. Due to the high risk for developmental delay and decreased social integration, early intervention should be considered in the treatment plan. Coping strategies for the patient (and the family) need to be addressed because of the chronicity of this syndrome. The primary care optometrist will be challenged by the individual with Alport syndrome since a balance between oculo-visual, developmental/psycho-educational and systemic care is required. A multi-disciplinary approach by the healthcare management team will enhance the quality of life and positive outcomes for these patients.

The hypocholesterolemic activities of pamaqueside and tiqueside, two structurally similar saponins, were evaluated in cholesterol-fed rabbits. The pharmacological profiles of the saponins were virtually identical: both dose-dependently decreased the intestinal absorption of labeled cholesterol 25-75%, increased fecal neutral sterol excretion up to 2.5-fold, and decreased hepatic cholesterol content 10-55%. High doses of pamaqueside (>5 mg/kg) or tiqueside (>125 mg/kg) completely prevented hypercholesterolemia. Decreases in plasma and hepatic cholesterol levels were strongly correlated with increased neutral sterol excretion. Ratios of neutral sterol excreted to pamaqueside administered were greater than 1:1 at all doses, in opposition to the formation of a stoichiometric complex previously suggested for tiqueside and other saponins. Ratios in tiqueside-treated rabbits were less than unity, a reflection of its lower potency. Pamaqueside-treated rabbits exhibited a more rapid decline in plasma cholesterol concentrations than control animals fed a cholesterol-free diet, indicating that the compound also inhibited the absorption of biliary cholesterol. Intravenous administration of pamaqueside had no effect on plasma cholesterol levels despite plasma levels twice those observed in rabbits given pamaqueside orally. These data indicate that pamaqueside and tiqueside induce hypocholesterolemia by blocking lumenal cholesterol absorption via a mechanism that apparently differs from the stoichiometric complexation of cholesterol hypothesized for other saponins.

We performed a preliminary clinical evaluation of digitized mammograms to assess whether digital images suitable for telemammography could be obtained. Thirty mammograms were digitized at a resolution of 4000 x 4000 pixels and 12 bit/pixel. The series contained 17 carcinomas in 16 patients. Five consultant radiologists reported both the original mammograms and the digitized images. There was agreement between the reports of the mammograms and the digitized images in relation to whether a suspicious lesion was present or not in 95% of cases. No study considered benign on viewing the film images was interpreted as malignant on reporting the digitized images. This suggests that film digitizers may allow a digital image of a mammogram of acceptable quality for telemammography to be obtained in the absence of a purpose-built digital mammography system.

We have explored the use of steroidal glycosides as cholesterol absorption inhibitors which act through an unknown mechanism. The lead for this program was tigogenin cellobioside (1, tiqueside) which is a weak inhibitor (ED50 = 60 mg/kg) as measured in an acute hamster cholesterol absorption assay. Modification of the steroid portion of the molecule led to the discovery of 11-ketotigogenin cellobioside (5, pamaqueside) which has an ED50 of 2 mg/kg. Replacement of the cellobiose with other sugars failed to provide more potent analogs. However, large improvements in potency were realized through modification of the hydroxyl groups on the cellobiose. This strategy ultimately led to the 4", 6"-bis[(2-fluorophenyl)carbamoyl]-beta-D-cellobiosyl derivative of 11-ketotigogenin (51) with an ED50 of 0.025 mg/kg in the hamster assay, as well as the corresponding hecogenin analog 64 (ED50 = 0.07 mg/kg).

This survey of 22 baccalaureate (BSN) programs was undertaken to describe and analyze work load issues in BSN nursing education. Academic careers of nursing faculty may be at risk because clinical work load policies generally place less value on clinical teaching than on classroom teaching. Research question addressed teaching credit hours received for each clinical contact hour, remaining weekly hours available for clinical faculty to accomplish service and research activities, and student-to-faculty ratios in clinical settings. Seventy per cent of the programs surveyed allocated less than 1 teaching credit hour to 1 clinical contact hour. Nursing faculty who taught clinical courses with 5:1 to .25:1 work load credit for face-to-face contact hour ratios needed to work between 8 and 24 hours more in face-to-face teaching compared with colleagues teaching lecture courses, thus leaving less time for scholarship and service activities. Fifty per cent of the programs reported 10 or more students in some of the clinical courses. Faculty reported concerns about quality of learning experiences and supervisory difficulties as student numbers in clinical courses exceeded 8 students/faculty member.

Background: Evidence from breast screening programs demonstrates the value of mammography in the detection of asymptomatic breast cancer., Methods: This study prospectively assessed the role of mammography in the management of 585 patients presenting to a breast clinic, over a 1-year period, with symptomatic breast disease and without clinical or cytological evidence of malignancy., Results: Eighteen (3%) of these patients had breast cancer. Eight patients presenting with nonspecific nodularity had carcinoma. All patients had relatively early disease., Conclusions: This study suggests that patients with symptomatic disease presenting to a breast clinic represent a group at higher risk of malignancy than screened asymptomatic patients, and that symptomatic women over 40 years of age should have bilateral mammography before being discharged from the breast clinic.

Purpose: To determine the relationship between the morphology of colon carcinomas detected with barium enema examination and the cancer stage., Materials and Methods: Clinical, radiographic, endoscopic, surgical, and histopathologic findings were retrospectively reviewed in 152 patients with colon cancer detected with barium enema examination during a 2-year period., Results: Eighty-six patients (57%) had lesions in the rectum and sigmoid and descending colon, and 66 (43%) patients had lesions more proximally in the colon. Lesions on the right side of the colon were less likely to cause symptoms than those on the left side. Eighty-one patients (53%) had annular or semiannular lesions, 57 (38%) had polypoid lesions, and 14 (9%) had plaquelike or carpet lesions. Six patients (4%) had Dukes stage A lesions; 84 (55%), Dukes stage B lesions; 42 (28%), Dukes stage C lesions; and 20 (13%), Dukes stage D lesions., Conclusion: Annular or semiannular carcinomas had higher rates of serosal invasion and lymph node metastasis than polypoid carcinomas, but the rates of liver metastases were comparable.

The mechanisms of action and selected agents for a variety of approaches to the treatment of atherosclerosis have been reviewed. In Table I, each approach is listed according to its primary physiological effect. This is a simplification, of course, and some agents, such as ACAT inhibitors, may have primary effects in all of these categories. As one goes from left to right, the benefit of each physiological effect becomes more speculative. There is no question of the benefit of LDL reduction, but less evidence exists for the clinical benefits of HDL elevation. With regard to direct anti-atherosclerotic effects, most approaches have yet to gather clinical data of any type. Perhaps as a result, the degree of medicinal chemistry effort in each area to date declines as one goes from left to right. This situation is changing rapidly, however. As evidence supporting the HDL hypothesis accumulates and knowledge of how to elevate HDL levels grows, very exciting opportunities for medical advances present themselves. Likewise, the knowledge base for nonlipid intervention is growing and very rapid advances are being achieved with the plaque-imaging techniques needed for evaluating such agents in man. Such results can only lead to greater opportunities for pharmacological intervention. Thus, in the future, much greater research effort will likely be dedicated to HDL elevation and nonlipid approaches. Through these efforts, physicians of the future should be armed with several complementary agents that can reduce the risk of cardiovascular disease in all patient populations.

Methyl (3R*,5S*)-(E)-3,5-dihydroxy-9,9-diphenyl-6,8-nonadienoate, CP-83101, was identified as a potent competitive inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase activity, inhibiting enzyme activity in vitro with an IC50 of 8.5 +/- 0.7 microM and a Ki with respect to HMG-CoA of 2.6 microM. CP-83101 also inhibited rat hepatic sterol biosynthesis by 39 +/- 7% at a dose of 100 mg/kg. [3H]CP-83101, administered orally to rats, exhibited peak plasma levels at approximately 1 hr that declined thereafter with an apparent half-time of 2-3 hr. Peak tissue levels also occurred 1 hr following oral administration of [3H]CP-83101. The decline in radioactivity in the liver, however, was considerably slower than that noted in blood, whereas the half-life in non-hepatic tissues was approximately 1 hr. Liver/blood ratios of 14, and liver/lens ratios of greater than 3000, following oral administration of [3H]CP-83101, were similar to those previously reported for other HMG-CoA reductase inhibitors, suggesting a high degree of tissue selectivity. In addition, liver/adrenal and liver/ovary ratios were approximately 1000 at all time points examined between 30 min and 24 hr following oral [3H]CP-83101 administration, indicating a high specificity for hepatic versus other steroidogenic tissues. Evaluation of intravenous versus oral administration of the water-soluble, free acid, sodium salt of [3H]CP-83101 in bile duct canulated rats indicated that approximately 20% of orally administered CP-83101 is absorbed from the gastrointestinal tract, and that absorbed CP-83101 is cleared rapidly from the plasma via the liver and from the liver via the bile. In addition, several lines of evidence suggest that CP-83101 may undergo enterohepatic recirculation. Agents of this synthetic series may thus possess advantages over other HMG-CoA reductase inhibitors with respect to tissue kinetics and specificity.

A series of 4-substituted 2-guanidinothiazoles has been found to inhibit the gastric proton-pump enzyme H+,K(+)-ATPase. In general, these compounds were reversible inhibitors of canine gastric H+,K(+)-ATPase, competitive at the K+ site, and selective relative to canine renal Na+,K(+)-ATPase. Structure-activity relationship (SAR) studies on this series revealed no general replacement for the guanidinothiazole. On the other hand, use of pyrrolyl, phenyl, and indolyl groups as the C-4 substituent yielded active compounds. Extensive studies of substitution patterns on these 4-aryl groups led to more active compounds, but no consistent SAR became apparent. Monosubstitution of the guanidine and substitution of the thiazole at C-5 both often led to increased activity, but combining these changes generated compounds less active than the parents. Despite 100-fold improvement in in vitro inhibitory potency, only a 3-fold increase in gastric antisecretory activity in rats was observed for these agents.

With the emphasis on quality assurance and patient satisfaction in health care, decision making in rehabilitative audiology is a critical issue. Traditionally, rehabilitative decisions have been based on questionable assessment procedures and unproven treatment methods. In this paper, current strategies for decision making with hearing-impaired adults will be presented. Discussion will focus on nonacoustic factors influencing hearing aid fitting, the decision processes necessary for management of the hearing-impaired adult, and expanded uses of self-assessment inventories of hearing handicap.

In three infants seen recently at our institution we noted signs of compression of the left main bronchus associated with enlarged left atria. None of our cases demonstrated the more usual signs of hyperinflation which are a hyperlucent lung field, depressed hemidiaphragm and mediastinal shift away from the affected side. In addition, hypoperfusion of the left lung was noted in each case. We believe that bronchial compression due to an enlarged left atrium, with consequent hypoxic vasoconstriction as a clinically significant entity, which is not well described and may be unappreciated in infants in whom the typical signs of hyperinflation are absent.

This article focuses on the range of fetal anomalies associated with varied alcohol ingestion during pregnancy. A means for identifying women at risk for having infants with alcohol related birth defects and the more severe fetal alcohol syndrome are discussed. Primary methods for preventing these lasting birth defects are described for practitioners.