Acute renal failure due to xanthine stones

A 9-month-old child with the skeletal abnormalities of Fuhrmann's syndrome presented with acute renal failure secondary to bilateral renal calculi. Hereditary xanthinuria was shown to be the underlying metabolic defect. Treatment with allopurinol was unsuccessful at reducing the xanthine excretion.

Oral capsaicin provides temporary relief for oral mucositis pain secondary to chemotherapy/radiation therapy

Pain from oral mucositis afflicts from 40% to 70% of patients receiving chemotherapy or radiation therapy. Current methods of clinical pain management (for example, topical anesthetics, systemic analgesics) have limited success. In a pilot study, we examined the ability of oral capsaicin to provide temporary relief of oral mucositis pain. Capsaicin, the active ingredient in chili peppers, desensitizes some neurons and has provided moderate pain relief when applied to the skin surface. Oral capsaicin in a candy (taffy) vehicle produced substantial pain reduction in 11 patients with oral mucositis pain from cancer therapy. However, this pain relief was not complete for most patients and was only temporary. Additional research is needed to fully utilize the properties of capsaicin desensitization and thus optimize analgesia.

Effect of recombinant growth hormone and chromium picolinate on cytokine production and growth performance in swine

The effect of dietary chromium picolinate (CrP) and recombinant porcine growth hormone, somatotropin (rPST) administration on growth performance and cytokine production in Landrace-Poland China gilts was determined using a 2 by 2 treatment array. Treatments were: (1) control (basal diet), (2) CrP-supplemented diet (basal diet + 300 micrograms Cr3+/kg diet as CrP), (3) rPST (100 pg/kg body weight/day), and (4) rPST+CrP. CrP-supplemented diets were fed beginning at 20 kg body weight through 90 kg. Administration of rPST was begun at 60 kg weight and continued through 90 kg. All rPST treated pigs demonstrated improvements in growth performance versus controls. Pigs given CrP-supplemented diets showed no differences in growth performance. At 90 kg, pigs were challenged with endotoxin (lipopolysaccharide, 0.2 microgram/kg i.v.). Blood samples were collected at 0, 1, and 3 h postchallenge. Plasma IL-6 levels increased from 23 U/ml at time 0 to 1,927 U/ml at 3 h for control swine. Swine from the CrP treatment group had IL-6 levels of 8,130 U/ml at 3 h post-LPS. There were no differences in plasma IL-6 from pigs in the rPST and rPST+CrP treatment groups compared to the controls. Endotoxin challenge had no effect on either blood glucose levels or induction of TNF-alpha in any treatment group. PBMC from CrP-treated animals produced more IL-2 than peripheral blood mononuclear cells from all other groups.

Oxytetracycline-mediated alteration of murine immunocompetence

The immunomodulatory effect of oxytetracycline (OTC) on murine splenic lymphocytes (MSL), peritoneal exudate macrophage (PEM) functions and antibody production was examined. In vivo exposure to OTC slightly delayed initiation of antibody formation during the primary response. However, OTC exposure had no effect on either the peak time of antibody response or peak antibody titer. OTC also had no significant effect on the secondary antibody response. Mitogen-induced proliferation of MSL cocultured with OTC and pokeweed mitogen, phytohemagglutinin or concanavalin was equivocal. However, allogeneic stimulation of MSL was inhibited at 100 micrograms/ml OTC. There was also a decrease in the number of cells recovered. OTC had no effect on lymphocyte cytotoxicity in cells cultured in vitro. OTC inhibited the cytotoxic response of Corynebacterium parvum-elicited PEM at 10 micrograms/ml (effector:target of 10:1). Low levels of OTC (1-10 micrograms/ml) augmented the cytotoxic response (effector:target of 5:1). The effect of OTC on induction of PEM cytotoxicity was assessed by coculturing thioglycollate-elicited (TG) PEM in vitro with IFN-gamma and endotoxin along with 0-100 micrograms/ml OTC. Induction of cytotoxicity was inhibited at 0.5 microgram/ml. The effect of OTC on TG-PEM antimicrobial activity was assessed by measuring reduction of nitroblue tetrazolium (NBT) and cytochrome C. OTC inhibited the reduction of NBT at 500 micrograms/ml following PMA stimulation of TG-PEM. OTC had no effect on either NBT or cytochrome C reduction following stimulation with opsonized zymosan. These results demonstrate that OTC-mediated immunosuppression is a multifaceted event, with differing sensitivities both between immune cells and between different pathways within the same cell.

Integrated health care management through comprehensive information systems

The true impact of a company's benefit strategy can be known only when relevant indicators can be adequately tracked, evaluated and brought together. An unparalleled opportunity exists to creatively apply computer technologies to address decision makers' needs for integrated health care information.

Persistent binocular diplopia following cataract surgery: aetiology and management

We studied all patients referred to the orthoptic department with binocular diplopia following cataract surgery between January 1991 and June 1993. Persistence of diplopia for a minimum of 3 months after cataract surgery was required for inclusion in the study. Eighty-one patients (2% of all patients who underwent cataract surgery during this time) satisfied the entry criteria. The patients fell into two groups: non-traumatic and traumatic cataracts. Horizontal deviations were seen in 24 patients. Vertical deviations were seen in 8 patients and a combined horizontal and vertical deviation was seen in 49 patients. Fresnel prisms were used to manage the diplopia in 58 patients. Of these, 48 patients in the non-traumatic group regained binocular single vision with this prism while 10 in the traumatic group benefited. Mechanical and sensory causes are discussed.

Effect of essential fatty acid deficiency on the fatty acid composition and arachidonic acid levels in rat maxillae and mandibles

The fatty acid composition of total lipids and total phospholipids of maxillae and mandibles of rats fed an essential fatty acid-deficient (EFAD), marginally FAD (MEFAD), and a control diet was determined. Patterns typical of an EFA deficiency such as a decrease in the levels of linoleic acid and archidonic acid along with concomitant increase in the levels of palmitoleic acid, oleic acid, and 5,8,11-eicosatrienoic acid were observed in the EFAD groups. Concentrations of arachidonic acid were significantly lower in total lipids of mandibles and maxillae of rats in the EFAD, but not in the MEFAD rats, than those of the controls.

Information processing by tree fellers: signal detection analysis

Eighteen experienced tree fellers and eighteen forestry students watched video recordings of mature eucalypts being felled by a man using a chain saw, and then rated whether each tree had fallen normally or abnormally. Signal-detection analysis showed that the tree fellers were more accurate than the forestry students in predicting eventual outcome. Further, the tree fellers achieved peak accuracy in discrimination by the time the logger had completed cutting the scarf (typically several minutes before the tree hit the ground), whereas the forestry students predicted outcome most accurately only when a tree was falling (and about 1 s from hitting the ground). Study of the bases for information processing and decision making by tree fellers has implications for personnel selection and training, as well as for formulation of effective work practices.

Isolation and characterization of a novel liver-derived immunoinhibitory factor

Cytosolic extracts prepared from perfused whole liver or purified hepatocytes of C57BL/6 mice inhibited interleukin-2--and concanavalin A--induced spleen cell proliferation in vitro. In contrast, cytosolic extracts from purified nonparenchymal liver cells had no effect. Arginase and very-low-density lipoprotein were previously identified as two immuninhibitory substances present in liver cytosolic extracts. We demonstrated, however, that inhibitory activity remained after removal of very-low-density lipoprotein and arginase from liver cytosolic extract by repeated ultracentrifugation and gel filtration chromatography, respectively, suggesting the presence of another inhibitor. Further purification by anion-exchange chromatography and chromatofocusing led to the isolation of a novel liver-derived immunohibitory factor. This liver-derived immunoinhibitory factor is sensitive to pronase digestion and heat and acid treatment; it has an estimated isoelectric point of 8.25. The Mr of liver-derived immunoinhibitory factor is 28 kD as estimated from its migration on sodium dodecyl sulfate-polyacrylamide gel electrophoresis, which is identical under both reducing and nonreducing conditions, indicating a monomeric nature of this protein. Amino acid composition analysis discloses that liver-derived immunoinhibitory factor is relatively rich in glycine and proline residues. Interleukin-2--induced spleen cell proliferation in vitro is inhibited by ths liver-derived immunoinhibitory factor, with a 50% inhibitory dose of 1.4 nmol/L. Furthermore, the biological activity of the liver-derived immunoinhibitory factor is not confined to mouse spleen cells, since the growth of B16 mouse melanoma and H35 rat hepatoma cells is also inhibited. A comparison with other liver-derived immunoinhibitors reported previously supports our claim that the liver-derived immunoinhibitory factor is a novel inhibitory protein.

Scottish cocaine users: wealthy snorters or delinquent smokers?

Ninety-two cocaine users were interviewed in Scotland. Most were middle-class nasal users, also used other drugs and generally gave cocaine a positive rating. One half of them had at some time used cocaine more than once a week. For some, this period lasted some months, when as much as 30 'lines' of cocaine were used per day of cocaine use. More of these heavy users reported adverse effects of cocaine than was the case for light users. Nonetheless, most heavy users had reduced their use by themselves to the point that their current cocaine use was no different from that of light users. Possible explanations for this apparently spontaneous reduction are discussed.

The impact of school-based drug education

Outcome evaluation of the impact of drug education on a representative sample of 1197 pupils revealed no effects of drug education on drug-related behaviour or drug-related attitudes. However, drug education raised levels of drug-related knowledge. The long term implications of these findings would require further study. Comparison of process and outcome measures indicated that, with the exception of knowledge, teachers' positive views of drug education were misplaced. Critical aspects of good practice are discussed, both at the level of the individual teacher and in terms of whole-school factors.

Measuring the efficiency of an artificial lung: 1. Carbon dioxide transfer

The performance of a hollow fibre artificial lung ('Capiox E') was analysed by measurement of the 'parallel deadspace' of the device under varying conditions in 21 patients. The efficiency with which carbon dioxide was exchanged was determined by the time available for equilibration between the blood and gas phases. When this equilibration coefficient was less than 12 seconds per litre of blood flow per litre of gas flow, there was a marked reduction in the efficiency of gas exchange. Under certain conditions, the 'counter-current' design of the device apparently permitted the clearance of carbon dioxide at a partial pressure greater than that which was found in the mixed venous blood. This anomalous behaviour may represent in vivo confirmation of the Haldane effect.

Information nurses need about AIDS

The practicing nurse in today's health care system will be caring for many AIDS-affected patients. To make appropriate care decisions and disseminate facts about the disease process to co-workers, patients, and the public, the nurse needs to be knowledgeable about more than just the prevention and transmission precautions. Nurses also need in-depth knowledge about the pathophysiology of the disease, diagnostic methods used to confirm the presence of AIDS and its opportunistic diseases, and nutritional implications for patients. With an understanding of the AIDS disease process, the nurse is in a position to be a key component on the health care team caring for AIDS-affected patients.

Con A-induced suppressor cell function depends on the activation of the CD4+CD45RA inducer T cell subpopulation

Human T cells incubated for 48 hr with Con A suppress B cell Ig production. We sought to define the interactions between CD4+ T cells and CD8+ T cells in the generation of suppressor cell activity following Con A stimulation. Con A-activated CD4+ inducer T cells suppressed Ig production in autologous cocultures of T cells and B cells by 84%, while PHA-activated CD4+ T cells could not. However, Con A-activated CD4+ T cells are not themselves suppressors. When Con A-activated CD4+ T cells were added to coculture of B cells plus T cells depleted of CD8+ T cells, no suppression of Ig production was observed. Furthermore, these Con A-activated CD4+ T cells were able to provide excellent help for Ig production. Therefore, Con A-induced suppressor cell function requires a CD4+ suppressor/inducer acting on a CD8+ suppressor/effector ultimately resulting in the down regulation of B cell Ig synthesis. Human CD4+ inducer T cells can be functionally dissected into helper/inducer or suppressor/inducer T lymphocytes based on their expression of either the CDw29 or CD45RA surface molecules, respectively. Following incubation with Con A the expression of CD45RA on CD4+ T cells increased from 34 to 80% (P = 0.001) while CDw29 expression was unchanged. Incubating lymphocytes with PHA resulted in a non-specific increase in both CD45RA and CDw29 expression by CD4+ T cells. The increase in CD4+CD45RA expression was a result of active proliferation by the Con A-stimulated T cells. Suppression of Ig secretion was directly correlated with the enhanced CD45RA expression following Con A activation. We demonstrate that enhanced suppressor/inducer function is unique to Con A stimulation and was not observed following activation by PHA. Furthermore, short-term culture with Con A results in the selective expansion of the CD4+CD45RA T cell subpopulation.

Sequestration of glyceryl trinitrate (nitroglycerin) by cardiopulmonary bypass oxygenators

The effectiveness of glyceryl trinitrate (nitroglycerin) in controlling myocardial ischemia and blood pressure during coronary artery bypass graft surgery is frequently lost during surgery, possibly as a result of drug sequestration by the cardiopulmonary bypass circuit. The objective of this study was to utilize a gas-liquid chromatographic assay to determine the extent of removal of glyceryl trinitrate from the priming fluid by the bubble and membrane oxygenators. The apparatus was maintained at either 25 or 37 degrees C, the two extreme temperatures experienced by the patient during bypass surgery. At apparent steady state, the circulating glyceryl trinitrate concentration was decreased by 20.6%, 46.6%, and 67.3% with the Maxima membrane oxygenator, Cobe membrane oxygenator, and Bentley bubble oxygenator, respectively. The three-layer defoaming filters that are used in the Bentley bubble oxygenator were studied by immersing each of the three filters in fluid containing 60 nM glyceryl trinitrate and monitoring the drug concentration in Plasmalyte. The filters sequestered approximately 90% of the glyceryl trinitrate from the bathing solution of which 31% was recovered with a single methanol wash of the polyurethane filter. These data demonstrate that the different oxygenators used in the cardiopulmonary bypass circuit remove glyceryl trinitrate to varying degrees from the circulating fluid.

What nurses don't know about AIDS

As nurses care for ever increasing numbers of AIDS patients, they will face increased challenges that will tax knowledge and skill levels. To make the appropriate assessments and decisions about care and educational needs of the patient, the nurse needs a complete knowledge base that includes information about the pathophysiology, physiologic needs of the patient, and the diagnostic tools related to the disease process.