Faculty Bibliography

When new studies are released, patients should consider them as updates, not the final word on a therapy or an illness. Medicine is more of an art than a science, and it should be tailored to meet an individual patient's needs. Therefore, not every new breakthrough will apply to every patient

Lamm, a physician, notes that he always feels "a sense of trepidation when a patient comes in complaining of stomach pain." Abdominal pain that is continous, severe, or accompanied by a fever warrants medical care

People with allergies should take comfort in the fact they they don't have to suffer. Important aspects of allergy care--such as prevention and early treatment--are discussed

The standard approach to treating obesity, which affects 20-30% of all Americans, does not work, and physicians need to develop new ways to help obese people. Treatment beyond behavior modification is needed as there appears to be a very real physiological basis for obesity

Lack of an immediate diagnosis often shakes a patient's faith in the doctor. The difficulty of pinpointing the specific cause of general symptoms and the anxiety it usually causes the parents of a patient are discussed

Sleeping pills rarely cure insomnia. Various sleep disorders, factors that can cause them and when to seek help for a sleeping disorder are discussed

Directly observed therapy (DOT) to enable completion of antituberculous therapy works. DOT is largely responsible for the recent improvement in tuberculosis case rates in New York City. Despite this favorable trend, the factors of significant HIV disease rates and of multidrug resistant forms of tuberculosis bacteria in the population are of grave concern. Therefore, in addition to DOT other means of preventing tuberculosis spread should be encouraged. These include directly observed preventive therapy (DOPT) programs, use of masks, improved ventilation in crowded settings such as homeless shelters, and ultraviolet light germicidal irradiation of upper room air in such locations.

The effects of beta-muricholic acid and hyocholic acid on cholesterol cholelithiasis were examined in two animal models. The following experiments were carried out: A) In a gallstone prevention study, prairie dogs were fed the lithogenic diet with or without 0.1% beta-muricholic or 0.1% hyocholic acid for eight weeks. B) In a second prevention study, hamsters were fed the lithogenic diet with or without 0.1% beta-muricholic acid or 0.1% hyocholic acid for six weeks. C) In a gallstone dissolution study, hamsters were fed the lithogenic diet for six weeks to induce stones; stone dissolution was examined during administration of a cholesterol-free purified diet with or without 0.1% beta-muricholic acid or 0.1% hyocholic acid. In the prevention study in prairie dogs (A), both bile acids failed to prevent stone formation, the cholesterol saturation index of bile was 0.89 in the lithogenic controls, remained unchanged with hyocholic acid and increased to 1.52 in the beta-muricholic acid group. In the prevention study in hamsters (B), beta-muricholic acid completely inhibited the cholesterol cholelithiasis (0% stone incidence); the cholesterol saturation index of bile was 1.78 (compared to lithogenic controls, 1.37). Hyocholic acid reduced stone incidence to 16% with a cholesterol saturation index of 0.98. In the dissolution study in hamsters (C), preexisting cholesterol gallstones were not dissolved by either hydrophilic bile acid after feeding these bile acids for an additional six weeks; at the end of the experiment, the cholesterol saturation indices were below unity.(ABSTRACT TRUNCATED AT 250 WORDS)

Male golden Syrian hamsters from Sasco form cholesterol gallstones when fed a lithogenic diet; in contrast, female hamsters are resistant to stones when fed the identical diet. Upon addition of the synthetic androgen, methyl-testosterone, to the diet, the incidence of cholesterol gallstones in female hamsters increased from 0% to 40% after 3 weeks and from 0% to 86% after 6 weeks. Cholesterol cholelithiasis remained high in the males. Biliary cholesterol and phospholipid levels were elevated in the females fed the hormone and approached those of the males. The cholesterol saturation of bile in the females increased from 36% to 75% after 3 weeks and from 54% to 109% after 6 weeks. In addition, an appreciable proportion of the cholesterol in the bile of female hamsters was now present in the form of vesicles. The bile acid composition was significantly altered by methyltestosterone even though the total bile acid concentration did not change; the bile acid composition of the female hamsters approached that of the males. The glycine to taurine ratio of the bile acids was drastically reduced by methyltestosterone in the females and to a lesser extent in males. In summary, in female hamsters the addition of methyltestosterone to the lithogenic diet induced cholesterol gallstones, elevated total biliary phospholipid and cholesterol, altered the bile acid composition, and changed the distribution of cholesterol from micelles to vesicles. The data obtained so far do not enable us to define the precise mechanism of action of methyltestosterone.