Segmental chloride transport in the Dahl-S rat kidney during L-arginine administration

L-Arginine normalizes pressure natriuresis in Dahl salt-sensitive (DS) rats. The nephron segments responsible for improvement in sodium chloride handling during L-arginine administration are unknown. Micropuncture techniques were used to examine fluid and chloride transport along superficial nephron segments in DS rats maintained on an 8% sodium diet and given L-arginine or vehicle ip for 3 wk. Renal perfusion pressure in vehicle-treated DS rats was reduced to that of L-arginine-treated DS rats with an aortic snare. Dahl salt-resistant (DR) rats receiving vehicle were examined for comparison. In agreement with previous studies, urinary sodium chloride excretion was greater (P < 0.05) in L-arginine DS rats than in vehicle DS rats and not different from DR rats at equivalent renal perfusion pressures. Whole-kidney and single-nephron GFR were not different (P = not significant) among groups. Fractional proximal tubule chloride and fluid reabsorption was not different among groups. Fractional loop chloride reabsorption was greater in vehicle-treated DS rats than in DR rats (58.5 +/- 1.5 versus 46.6 +/- 1.7%; P < 0.05), confirming the enhanced chloride reabsorption at this location in DS rats previously reported. Fractional loop chloride reabsorption was identical in vehicle- and L-arginine-treated DS rats (58.4 +/- 1.4 versus 58.9 +/- 3.9%; P = not significant). Fractional loop fluid reabsorption was not different among groups. Fractional distal fluid and chloride reabsorption was not different between DS rat groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Concurrent sickle cell hemoglobin C disease and diabetes mellitus: no added risk of proliferative retinopathy?

Of 148 adults with sickle cell hemoglobin C (SC) disease seen at Cook County Hospital and Clinics, Chicago, Illinois, eight patients had coexistent noninsulin-dependent diabetes mellitus. The clinical findings were notable for the paucity of retinal vascular changes. No patient showed proliferative diabetic retinopathy; one patient showed background diabetic retinopathy consisting of a few microaneurysms. Six of the eight patients showed no lesions of proliferative sickle retinopathy. Coexistence of noninsulin-dependent diabetes mellitus and SC disease does not appear to have an additive adverse effect on the presence or severity of proliferative retinopathy in the affected patient.

L-arginine improves transmission of perfusion pressure to the renal interstitium in Dahl salt-sensitive rats

L-Arginine normalizes pressure natriuresis in Dahl salt-sensitive (DS) rats. To determine the role of renal interstitial hydrostatic pressure (RIHP) in this phenomenon, we measured RIHP determined by servo-null during acute changes in renal perfusion pressure in anesthetized DS rats receiving L-arginine (300 mg.kg-1.day-1 ip) or vehicle for 3 wk. Dahl salt-resistant (DR) rats were controls. As observed previously, the slope of the pressure-natriuresis relationship was greater (P < 0.05) in L-arginine-treated DS rats than vehicle DS rats and not different from DR rats. The slope of the relationship between renal perfusion pressure and RIHP was greater (P < 0.05) in DR rats than vehicle DS rats. In L-arginine-treated DS rats the slope of this relationship was greater (P < 0.05) than that in vehicle DS rats and not different from DR rats. Removal of the renal capsule blunted the pressure-natriuresis relationship in L-arginine-treated DS rats but had no effect in vehicle DS rats. Thus L-arginine improves transmission of perfusion pressure into the renal interstitium in DS rats and may contribute to the improved pressure-natriuresis response.

Craniofacial excision for recurrent osteogenic sarcoma of maxilla

Two cases of recurrent osteogenic sarcoma of the antro-ethmoidal complex treated at our hospital by a craniofacial resection are presented. The imperative need to treat osteogenic sarcomas of the maxilla primarily by a radical approach such as a craniofacial resection is emphasized.

Recombinant alpha-interferon therapy in multiple myeloma

Three patients with multiple myeloma were treated with recombinant alpha-interferon (r IFN-alpha 2b Intron AR) along with combination chemotherapy i.e. melphelan and prednisolone. In one case it was given as an initial therapy, while the other two patients had refractory and relapsing disease respectively. IFN-alpha 2b was given in the dose of 2 x 10(6) Mu/m2 by subcutaneous injection thrice in a week for six months in two patients and for three months in one patient. All three patients experienced improvement in bone pains; partial response with reduction in the paraprotein level was seen in one patient; while there was no radiological, biochemical or haematological improvement in two patients. Side effects noted were flu like syndrome in all three patients and urticaria in one patient. They were treated symptomatically and did not require cessation of interferon therapy.

The accuracy and precision of the Accutracker ambulatory blood pressure monitor

Prerequisite to the use of ambulatory blood pressure monitors in epidemiologic research is demonstration of a satisfactory level of accuracy and precision. Previous evaluations of these devices raise a number of methodological concerns which complicate interpretation of their findings. Also, important issues regarding the precision of blood pressure measurements and the identification of factors associated with measurement inaccuracies remain unaddressed. To assess the accuracy and precision of the Accutracker ambulatory blood pressure monitor, we obtained five serial estimates of resting blood pressure on 120 ambulatory subjects in The Johns Hopkins Medical Institutions in 1987. Two Accutrackers and two manual observers independently recorded blood pressure with the order determined at random. The fourth observer in each sequence obtained a replicate measurement. For both systolic and diastolic blood pressures, the mean difference between Accutracker and manual measurements was less than 3 mmHg for each pairwise comparison. Scatter plots and regression analyses demonstrated that both Accutrackers tended to underestimate high systolic and diastolic blood pressures. In bivariate and multivariate analyses, increased age was significantly associated with underestimation of systolic blood pressures by both Accutrackers. With respect to the precision of blood pressure measurement, no significant differences were present among the four observers. In summary, our data suggest that the Accutracker has satisfactory accuracy and precision, but that accuracy is not uniform across patient subgroups.

Elective versus therapeutic neck dissection in early carcinoma of the oral tongue

A prospective, randomized trial was carried out to assess the value of elective versus therapeutic neck dissection in early squamous cell carcinoma of the oral tongue. Disease-free survival (median follow-up 20 months) was 52 percent versus 63 percent in patients who underwent hemiglossectomy alone and those who underwent hemiglossectomy and radical neck dissection, respectively (difference not statistically significant). Patients with a tumor depth of less than 4 mm did significantly better than those with a tumor depth of greater than 4 mm; they were also more likely to have uninvolved nodes at elective radical neck dissection compared with those with a tumor depth of greater than 4 mm. However, when the survival rates of patients in the two treatment groups were compared with respect to a tumor depth of 4 mm, there was no significant difference between the hemiglossectomy and the hemiglossectomy and radical neck dissection groups. A policy of interval elective radical neck dissection only in those with a tumor depth of greater than 4 mm may optimize cure rates and avoid neck dissection in those unlikely to develop neck recurrence.

Delayed hemolytic transfusion reactions in sickle cell anemia

Delayed hemolytic transfusion reaction (DHTR) developed in three patients with sickle cell anemia seen over an 18-month period at Cook Country Hospital. The DHTR was associated with severe pain crisis, with spherocytic hemolytic anemia, a positive direct antiglobulin test result, previously undetected erythrocyte alloantibodies, and disappearance of Hb A on cellulose acetate electrophoresis. Delayed hemolytic transfusion reactions may be more common than is generally recognized and should be considered when a patient has a sickle cell pain crisis shortly after receiving a transfusion.

Prophylactic neck dissection in squamous cell carcinoma of oral tongue: a prospective randomized study

This paper presents the first report of an ongoing prospective randomised clinical trial in early T1T2N0 carcinoma of the oral tongue. The problems of regular follow-up in an indigent population from the vast rural expanse of India has been successfully overcome in this trial by close personal follow-up. The trial addresses itself specifically to prophylactic vs. therapeutic surgical management of the neck in T1T2N0 patients with cancer of the oral tongue. Overall disease, free survival (median follow-up 22 months) is higher (64% vs. 47%) in the group receiving prophylactic neck dissection. Disease-free survival for those with positive nodes at prophylactic neck dissection was twice that of those who underwent a subsequent therapeutic neck dissection (57% vs. 28%). Contralateral neck node metastasis has been identified as a significant factor in neck failures in those patients undergoing simultaneous prophylactic neck dissection.

Comparative analysis of glycosylated hemoglobins by ion-exchange column chromatography and high-performance liquid chromatography in patients with hemoglobinopathies

Cation-exchange chromatography gives falsely decreased values for glycosylated hemoglobins (GHbs) in patients with abnormal hemoglobins (Hbs) such as S, D, G, C, E, and O. This decrease is thought to be proportional to the percentage of abnormal Hb present. In the authors' study, cation-exchange column chromatographic GHb values on 84 nondiabetic patients heterozygous for Hb S, 28 AS diabetic patients, and 23 nondiabetic patients heterozygous for Hb C were calculated to account for the percentage of abnormal Hb, and the resulting values were compared with the GHb values obtained by high-performance liquid chromatography (HPLC). There existed a good correlation between the calculated GHb and the GHb obtained by HPLC (r = 0.92 for AS and r = 0.94 for AC). In patients with elevated Hb F, chromatographic GHb values are falsely high. In such cases, correction can be made by subtracting the Hb F value from the observed GHb. In laboratories where cation exchange chromatography is used, accurate determination of GHb can be made by adjusting observed values for portion of the abnormal Hb present.

Sports injuries as seen at an accident and emergency department

We present certain characteristics of 1,000 consecutive patients who attended an Accident and Emergency Department (A&E) with an injury sustained as a result of sport. The majority of injuries occurred as a result of football. Sports injuries had a higher requirement of X-ray than general trauma patients. A minority were treated at the site of injury. A fifth of patients required no treatment or a simple dressing. Commonest treatment was a support bandage. Only 2% required immediate in-patient treatment. Those affected by sports injuries tend to be young and of working age and may lose work time as a result of their injuries and therefore appropriate treatment is justified.

Sports injuries' postal survey: difficulties encountered in assessment of outcome

We present the results of a postal survey on the outcome of sports injuries treated in an Accident and Emergency Department which shows that this is unsuitable for assessing their outcome. There are, however, some points of interest relating to associated morbidity and satisfaction with treatment in the Accident and Emergency Department.

Five years' experience of bacteraemia in sickle-cell anaemia

In a review of all adults admitted with sickle-cell anaemia to Cook County Hospital between January 1980 and April 1985, 15 instances of bacteraemia were identified. In these patients, bacteraemia was characterised by slow onset, an identifiable focus of infection and lack of hypotension or abnormal coagulation of the blood. The organisms, most often isolated were Escherichia coli and Salmonella species. Two patients died, both with Salmonella enteritidis bacteraemia. Neither death could be attributed to the acute effects of infection. The outcome of bacteraemia in adults with sickle-cell anaemia appears to be more favourable than that in children.

Pulmonary edema associated with subarachnoid hemorrhage. Evidence for a cardiogenic origin

A 56-year-old woman with no history of cardiac disease developed acute pulmonary edema following a subarachnoid hemorrhage. A constellation of findings, including elevated creatine kinase MB isoenzyme activity in the absence of electrocardiographic or scintigraphic evidence of acute myocardial infarction, elevated pulmonary artery wedge pressure, segmental wall motion abnormalities, and depressed ejection fraction of the left ventricle demonstrated by two-dimensional echocardiography and radionuclear ventriculography, pointed to a direct myocardial injury leading to cardiac failure. The evidence for cardiogenic origin of pulmonary edema provided by this case is in contrast to the belief that "neurogenic" pulmonary edema is of noncardiac origin.