Reset Osmostat: Facts and Controversies

Reset osmostat (RO) consists of a change in the normal plasma osmolality threshold (reduction or increase), which consequently induces chronic dysnatremia (hyponatremia or hypernatremia). Although the early papers on RO state that hyponatremic patients with this condition are usually not symptomatic, the current view is that most patients with hyponatremia are symptomatic and should be treated. RO has been associated with a myriad of clinical conditions and has clear diagnostic criteria which are crucial to arrive at the correct diagnosis and treatment.

An LC/MS/MS method for quantitation of chemopreventive sphingadienes in food products and biological samples

Colorectal cancer (CRC) is a leading cause of cancer mortality. Diet has a significant influence on colon cancer risk. Identifying chemopreventive agents, dietary constituents, practices and/or diet supplements that promote gut health and reduce the incidence of intestinal neoplasias and CRC could significantly impact public health. Sphingadienes (SDs) are dietary sphingolipids found in plant-based food products. SDs are cytotoxic to colon cancer cells and exhibit chemopreventive properties. The aim of the present study was to develop a sensitive and robust ultra-high performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) method for quantifying SDs in food products and biological samples. The assay was linear over a concentration range of 80nM to 50μM and was sensitive to a detection limit of 3.3nM. Post-extraction stability was 100% at 24h. SD content in soy oils was approximately 10nM. SDs were detected transiently in the plasma of adult mice 10min after gavage delivery of a 25mg/kg bolus and declined to baseline by 1h. SD uptake in the gut was maximal in the duodenum and peaked 1h after gavage delivery. Disappearance of SDs in the lower gastrointestinal tract suggests either rapid metabolism to yet unidentified products or potentially luminal export.

Effect of surgeon education on lymphadenectomy in colon cancer

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Background: The most important determinant of prognosis for localized colon cancer is metastatic lymph node involvement. The American Joint Commission on Cancer and the College of American Pathologists have recommended examination ≥ 12 lymph nodes to ensure adequate staging. We hypothesized that surgeon education would improve the extent of lymphadenectomy in patients being treated for colon cancer. A large community based metropolitan health care system served as a model for testing this hypothesis.

Methods: 906 patients comprising AJCC stage I (n=265), stage II (n=304), and stage III (n=337) colon cancers were evaluated. Surgical approach was either open (n=567), laparoscopic (n=310), or unknown (n=29). Lymphadenectomy results obtained from post-operative pathology reports were tracked across four separate time periods: era 1 (1/1/02-1/31/04), era 2 (1/1/05-1/31/06), and era 3 (1/1/07-1/31/07). Results were then compared against a study endpoint measurement of 2008, era four.

Results: Upon analysis and comparison of individual era results, a significant improvement in lymphadenectomy (percentage of patients with ≥12 nodes harvested) was noted for all AJCC stages (p-values compare era 4 versus era 1): I (34.2% vs. 59% vs. 65% vs. 69%, P=0.0001), II (62% vs. 76% vs. 90% vs. 91%, P=0.0004), and III (55% vs. 72% vs. 84% vs. 86%, P<0.0001; see table). Surgical approach was not a significant factor. Neither age nor sex was significant.

Conclusions: Through physician education, we were able to increase awareness of optimal staging practice for lymphadenectomy in colon cancer. This resulted in significantly improved patient outcomes within a large metropolitan health care system.

No significant financial relationships to disclose.

Circulating and adipose tissue gene expression of zinc-alpha2-glycoprotein in obesity: its relationship with adipokine and lipolytic gene markers in subcutaneous and visceral fat

CONTEXT

Zinc-alpha2-glycoprotein (ZAG) is a soluble protein similar to the class I major histocompatibility complex heavy chain, which has been implicated in lipid catabolism. We hypothesized that ZAG mRNA expression in adipose tissue may be linked with lipolytic and adipokine gene expression and have a close relationship with clinical phenotype.

OBJECTIVES

The objective of the study was to analyze ZAG gene expression in human adipose tissue from lean and obese subjects. ZAG circulating plasma levels and its relationship with cardiometabolic risk factors were also studied.

DESIGN

Seventy-three Caucasian (43 male and 30 female) subjects were included. Plasma and adipose tissue [sc (SAT) and visceral (VAT)] from the same patient were studied. mRNA of PPARgamma, hormone-sensitive lipase (HSL), adipose triglyceride lipase, adiponectin, omentin, visfatin, and ZAG were quantified. Plasma concentrations of ZAG were determined with ELISA.

RESULTS

ZAG plasma levels showed a negative correlation with insulin (r = -0.39; P = 0.008) and the homeostasis model assessment for insulin resistance index (r = -0.36; P = 0.016). No differences in ZAG circulating levels according to body mass index classification were observed. ZAG expression in SAT was significantly reduced in overweight and obese individuals compared with lean subjects (P < 0.001 and P = 0.007, respectively). ZAG mRNA expression in both SAT and VAT depots were negatively correlated with many clinical and metabolic cardiovascular risk factors. After multiple linear regression analysis, SAT ZAG was mainly predicted by adiponectin mRNA expression (B = 0.993; P < 0.0001) and plasma triglyceride levels (B = -0.565; P = 0.006). VAT ZAG expression was predicted by adiponectin expression (B = 0.449; P < 0.0001), and HSL VAT expression (B = 0.180; P = 0.023).

CONCLUSIONS

The present study provides evidence of a role of ZAG gene in adipose tissue metabolism, with a close association with adiponectin gene expression in sc and visceral fat.

Determinants of sex hormone-binding globulin concentrations in a cross-sectional study of healthy men randomly selected

Sex-hormone binding globulin (SHBG) is a glycoprotein synthesised in the liver and it is a transport protein which is primary modulator of the androgen signal. This cross-sectional study prompted us to investigate the relati-onship between SHBG and, age, anthropometric, body composition variables, the IGF-I system and leptin in a group of healthy adult men randomly selected. Included 134 men, aged 41.6 years, range 15-70 years. Body mass index (BMI) was calculated, and body composition was determined by a bioelectrical impedance analyser. Serum total IGF-I concentrations after acid-ethanol extraction, free IGF-I concentrations, IGFBP3, leptin, testosterone and SHBG were determined. Testosterone concentrations increased in the 2th decade and SHBG concentrations increased in the 4th decade. We observed an increase in leptin in the 4th decade with a decrease in IGF-I, free IGF-I and IGFBP3 throughout the decades. Total IGF-I correlated with waist/hip ratio; free IGF-I with BMI and waist/hip ratio and IGFBP3 did not correlated with any variable. As expected, there was a positive correlation between leptin and BMI, waist/hip ratio, fat free mass and fat mass. On the other hand, SHBG was negatively correlated with BMI, fat mass, total IGF-I, free IGF-I, IGFBP3 and leptin. Testosterone did not correlated with any anthropometric or body composition variable, IGF-I system components, leptin or SHBG. The multiple linear regression analysis produced a model that explained the 40.5% of SHBG variability; only fat mass and IGFBP3 brought an independent significant contribution to SHBG variability. In conclusion, in this population of healthy men randomly selected, we found that they had significant negative correlation between SHBG concentrations and anthropometric, body composition variables, the IGF-I system and leptin levels, and that fat mass and IGFBP3 may be the main determinants of SHBG changes.

Efficacy of eprinomectin pour-on in naturally Oestrus ovis infested merino sheep in Extremadura, South-West Spain

The aim of this study is to evaluate the efficacy of the eprinomectin pour-on in naturally Oestrus ovis-infested sheep. To carry out this trial, 14 naturally infected sheep from the same flock were used. The animals were randomly distributed in three groups: group 1 (non-treated sheep), group 2 treated with 0.5 mg/kg bodyweight and group 3 treated with 1 mg/kg bodyweight of eprinomectin. The sheep were slaughtered 15 days after treatment and their heads were sectioned to count and identify larvae instar. The following results were obtained: Group 1: the average was 34 live and 0.75 dead larvae per sheep. Group 2: the efficacy of the eprinomectin was 83.5% against O. ovis group 3: the efficacy of the eprinomectin pour-on was 100%. Drug analysis was made to determine plasma eprinomectin concentration 9 days after treatment and the average concentrations in groups 2 and 3 were 1.23 and 3.04 ng/ml, respectively. The statistical study showed a significant difference between the efficacy and the dose used, and there was correlation between the plasma concentration of eprinomectin and the dose. The efficacy and easy application allow us to take into account this endectocide as an alternative method in the integral control of parasites in sheep.

Closed versus partially ventilated endotracheal suction in extremely preterm neonates: physiologic consequences

This randomized cross over study aimed to compare the severity and incidences of desaturation and bradycardia between the partially ventilated endotracheal suction method (PVETS) and closed tracheal suction system (CTSS) in extremely preterm neonates. Fifteen intubated and ventilated extremely low birth weight preterm infants (mean birth weight 689g) randomly underwent both suction techniques within a 12-h period to obtain a paired reading group. The process was repeated 24-48h apart until three pairs of reading groups were collected. Changes in oxygen saturation measured with pulse oximetry and heart rate changes measured with electrocardiogram were recorded using Hewlett-Packard m240A monitor trending software. The mean of each parameter's variation from baseline was obtained using SPSS descriptive statistics and analyzed using SPSS repeated measures ANOVA. Fisher Exact Test was used to analyze the incidence of desaturation and bradycardia. The closed tracheal suction system reported a significantly smaller degree of oxygen saturation fall (P<0.005) and significantly fewer incidences of desaturation. There was also a significantly smaller degree of heart rate reduction although episodes of bradycardia were not significantly different between the two methods. Oxygen saturation and heart rate were significantly more stable during the use of CTSS compared to PVETS in the extremely low birth weight preterm population.

Location and effects of long-term NaCl stress on superoxide dismutase and ascorbate peroxidase isoenzymes of pea (Pisum sativum cv. Puget) chloroplasts

The present work describes the intrachloroplast localization and the changes that took place in the thylakoid and stroma-located superoxide dismutases (SOD, EC 1.15.1.1) and ascorbate peroxidases (APX, EC 1.11.1.11), in response to long-term NaCl stress in Pisum sativum L. cv. Puget plants. Native PAGE using high chloroplast protein concentrations pointed to the presence of the two main Fe-SODs, together with CuZn-SODs, both in thylakoids and in the stroma. Western blot and immunogold labelling using the antibodies against chloroplastic Fe-SOD from Nuphar luteum also confirmed the chloroplastic localization of a Fe-SOD. Thylakoidal Fe-SOD activity was induced by a NaCl concentration as low as 70 mM, while CuZn-SOD was induced at 90 mM, although in severe stress conditions (110 mM) both activities were similar to the levels at 90 mM NaCl. NaCl stress also induced stromatic Fe-SOD and CuZn-SOD activities, although these inductions only started at higher NaCl concentration (90 mM) and were significant at 110 mM NaCl. The increase in activity of both Fe-SODs was matched by an increase in Fe-SOD protein. Chloroplastic APX isoenzymes behaved differently in thylakoids and stroma in response to NaCl. A significant increase of stromal APX occurred at 70 mM, whereas the thylakoidal APX activity was significantly and progressively lost in response to NaCl stress (70-110 mM). A significant increase in the H2O2 content of chloroplasts during stress and a reduction in the ascorbate level at 90 mM NaCl also took place, although the oxidized ascorbate pool at the highest NaCl concentration did not show significant changes. These results suggest that the loss of thylakoidal APX may be an important factor in the increase in chloroplastic H2O2, which also results from the increased thylakoid and stroma-located Fe-SOD and CuZn-SOD activities. This H2O2 may be involved in the induction of stromal APX. The up-regulation of the above enzymes in the described stress conditions would contribute to the adaptation of cv. Puget plants to moderate NaCl stress.

Idiopathic chronic fetomaternal haemorrhage resulting in hydrops--a case report

INTRODUCTION

We report a case of idiopathic chronic fetomaternal haemorrhage (FMH) that developed in the late trimester.

CLINICAL PRESENTATION

The patient presented with decreased fetal movement at 38 weeks gestation. Antenatal follow-up was uneventful with normal serial ultrasound performed at 22 and 35 weeks. Prior to delivery, the cardiotocography (CTG) was abnormal with decreased baseline variability and late deceleration. Emergency lower segment caesarean section was performed. Upon delivery, a hydropic neonate with a haemoglobin level of 3.9 g/dL was noted. The Kleihauer-Betke test was positive, confirming FMH.

OUTCOME

The neonate later developed intraventricular haemorrhage (IVH) and spastic cerebral palsy on follow-up.

DISCUSSION

It is possible for FMH to occur late at the third trimester leading to detrimental effect. The fact that FMH can occur without antecedent risk factors underscores the importance of further research, and a high index of suspicion.

Contribution of phospholipomannan to the surface expression of beta-1,2-oligomannosides in Candida albicans and its presence in cell wall extracts

beta-1,2-Oligomannosides (beta-1,2-Man) derived from Candida albicans mannan have been shown to act as adhesins and to induce protective antibodies. We used monoclonal antibodies specific for beta-1,2-Man in electron, confocal, and fluorescence microscopy to study the surface expression of beta-1,2-Man epitopes. These monoclonal antibodies were also used for Western blotting of cell surface extracts to study the nature of the molecules expressing the beta-Man epitopes. Evidence was obtained for the contribution of a glycolipid, phospholipomannan (PLM), to the complex expression of beta-1,2-Man epitopes at the cell wall surfaces of yeasts grown on solid media. PLM was present in intercellular matrixes of colonies grown on agar and was detected as a contaminant in mannan batches prepared by conventional methods.

Newborn screening in Singapore

Neonatal screening in Singapore for G6PD deficiency started in 1965. Screening for congenital hypothyroidism started in 1981 as a pilot research program and by 1990, it became nationwide. Screening for congenital hypothyroidism is by the measurement of TSH in the cord serum with recall of those exceeding the 99th percentile, by about 3-4 days of life. Treatment is usually started within a week of life. Over 400,000 newborns have been screened and the screening rate has been about 99.95%. The incidence rate is about 1 in 3,000. G6PD activity in the cord blood is measured using semi-quantitative rapid screening tests. Those identified are physically protected from environmental triggers by keeping them in hospital for a variable period of time. Parents are counseled. Data obtained from 22,830 newborns from the National University Hospital revealed incidence rates of 1.62% in all newborns, 3.15% in males and 0.11% in females. The Chinese and Malay males had a higher (3.94% and 2.95%) incidence respectively when compared to the Indian males with (0.66% incidence). The application of the preventive measures has resulted in no report of kernicterus in the last 20 years. Our efforts are now focused on minimizing the recall rate in the case of hypothyroidism screening, reducing the period of stay in hospital in those with G6PD deficiency and considering the introduction of a PKU screening program in Singapore.

Mass newborn screening for glucose-6-phosphate dehydrogenase deficiency in Singapore

Recognition of kernicterus as a significant contributor to newborn mortality and morbidity in G6PD deficient babies and the ease with which G6PD deficiency could be detected and kernicterus prevented by avoidance of triggers, led to the establishment of mass newborn screening for G6PD deficiency in 1965. G6PD deficient newborns are identified within a day of birth by measuring the enzyme activity in cord blood. They are then physically protected from triggers by keeping them in the hospital for the first 2 weeks of life after their parents are counseled. Enzyme activity is measured using Wong's in-house modification of the Bernstein's technique or the BM G6PD Deficiency Screening test based on the Beutler assay. Close to 1.6 million newborns, representing practically 100% of all births have been screened. Analysis of data from 22,830 newborns at the National University Hospital reveals an incidence of 1.62% in all newborns. 3.15% in males and and 0.11% in females. A distinct racial variation in the incidence of deficiency was observed in males: Chinese 3.94%, Malays 2.95% and Indians 0.66%. Intermediate deficiency was most frequently identified (1.83%) in Chinese females. With the preventive measures. the incidence of kernicterus has dropped dramatically and there has been, over the last 20 years, no reported cases of kernicterus in newborns with G6PD deficiency. We are now looking at issues like comparing different assay techniques and determining a shorter period of stay in hospital. We believe that all Asians, especially Chinese babies, should be screened for G6PD deficiency, irrespective of which country the child is born.

Selective oxidation of a keramaphidin B model

A crucial step in the Baldwin and Whitehead proposal for explaining the biogenesis of the marine alkaloid manzamine A is the selective oxidation of natural keramaphidin B to an iminium salt 3, which is then hydrolyzed to give the aldehyde 4. Conditions are now presented in which this selective oxidation can be performed on model compound 8, leading to the iminium salt 16. Although this salt can be considered as a model equivalent of the proposed aldehyde intermediate 4, it was found to be very resistant to hydrolysis as was the corresponding amide 20. From a synthetic point of view, the reported results illustrate the usefulness of the temporary protection of tertiary amines as aminoborane derivatives and constitute a good method for the oxidation of a sterically hindered tertiary nitrogen atom in the presence of a second nitrogen.

Growth hormone and thyrotropin hormone secretion in Alzheimer's disease

The present study examined the relationship among GH and TSH secretion and neuropsychological and morphological tests in patients with Alzheimer's disease (AD). We studied 28 healthy controls and 28 AD patients with psychoneurological tests, and correlated their data with morphological data obtained by computed tomography and hormone responses of GH to GHRH, and TSH to TRH. The GH response to GHRH was higher in AD patients than in controls, 12.2 +/- 2 vs. 5.2 +/- 2.1 mcg/l, p< 0.01 but there was no difference in TSH response to TRH. On neuropsychological tests, patients were classified into 3 stages, these were indistinguishable on the basis of morphological data, GH and TSH responses at all stages including early-onset. Although GH response to GHRH was higher in AD patients than in controls, our results suggest that psychometric discrimination may be more accurate in diagnosis and staging of AD, than in predicting by morphological and hormonal responses.

Growth hormone receptors in ovary and liver during gametogenesis in female rainbow trout (Oncorhynchus mykiss)

Changes of growth hormone receptivity in the ovary during the reproductive cycle were studied in rainbow trout (Oncorhynchus mykiss). A method for characterizing growth hormone receptors in crude ovary homogenate was required for this. Binding of radiolabelled recombinant rainbow trout growth hormone (125I-labelled rtGH) to crude ovary preparation was dependent on ovarian tissue concentration. The sites were specific to growth hormone, with no affinity for prolactins and gonadotrophins. Similar high affinities for 125I-labelled rtGH were obtained with crude ovary (4.2 x 10(9) +/- 0.3 mol l-1) and crude liver preparations (4.9 x 10(9) +/- 0.1 mol l-1) at all stages of ovogenesis, and with ovarian membrane preparations (8.2 x 10(9) mol l-1) tested at the beginning of vitellogenesis. Ovarian growth hormone receptor concentration was highest during the early phases of follicular development (endogenous vitellogenesis: 315-310 fmol g-1 ovary) and decreased regularly during oocyte and follicular growth (exogenous vitellogenesis) to reach a minimal value at oocyte maturation (42 fmol g-1 ovary). In postovulated fish, binding was at a similar level (297 fmol g-1 ovary) to that found in endogenous vitellogenesis. Conversely, the absolute binding capacity of the whole ovary was low from immaturity to early exogenous vitellogenesis (0.1-0.6 pmol per pair of gonads), increased slowly during vitellogenesis and more markedly during rapid oocyte growth and at the time of final maturation (10.8 pmol per pair of gonads). In postovulated fish, the absolute binding capacity decreased partially (4.4 pmol per pair of gonads). Mean hepatic growth hormone receptor concentration did not vary with the reproductive stage for most of the cycle (3.0-4.5 pmol g-1 liver) except in endogenous vitellogenesis where significantly higher concentrations were observed (6.7 pmol g-1 liver). Individual ovarian growth hormone receptor concentrations were correlated with hepatic growth hormone receptor concentrations, indicating that they are regulated in a similar way. We conclude that growth hormone receptors are present in the ovary during the entire ovarian cycle in rainbow trout, probably mainly in somatic cells as indicated by the same concentration of binding sites in immature and in postovulated fish. Growth hormone is potentially important during oocyte recruitment in vitellogenesis and initiation of growth and during final follicular maturation.

Growth hormone (GH) and gonadotropin subunit gene expression and pituitary and plasma changes during spermatogenesis and oogenesis in rainbow trout (Oncorhynchus mykiss)

In order to evaluate potential interactions between somatotropic and gonadotropic axes in rainbow trout (Oncorhynchus mykiss), changes in pituitary content of the specific messenger RNA of growth hormone (GH) and gonadotropin (GTH) alpha- and beta-subunits were studied during gametogenesis with respect to pituitary and plasma hormone concentrations. Quantitative analyses of mRNA and hormones were performed by dot blot hybridization and homologous RIA on individual fish according to stage of spermatogenesis and oogenesis. All transcripts were detectable in 9-month-old immature fish. GH, GTH IIbeta, and GTH alpha increased moderately throughout most of gametogenesis and then more dramatically at spermiation and during the periovulatory period. GTH Ibeta mRNA increased first from stage I to V in males and more abruptly at spermiation, while in females GTH Ibeta transcripts increased first during early vitellogenesis and again around ovulation. Pituitary GH absolute content (microgram/pituitary, not normalized with body weight) increased slowly during gametogenesis and more abruptly in males during spermiation. In the pituitary of previtellogenic females and immature males, GTH I beta peptide contents were 80- to 500-fold higher than GTH II beta peptide contents. GTH I contents rose regularly during the initial phases of vitellogenesis and spermatogenesis and then more abruptly in the final stages of gonadal maturation, while GTH II contents show a dramatic elevation during final oocyte growth and maturation, in postovulated females, and during spermiogenesis and spermiation in males. Blood plasma GTH II concentrations were undetectable in most gonadal stages, but were elevated during spermiogenesis and spermiation and during oocyte maturation and postovulation. In contrast, plasma GTH I was already high ( approximately 2 ng/ml) in fish with immature gonads, significantly increased at the beginning of spermatogonial proliferation, and then increased again between stages III and VI to reach maximal levels ( approximately 9 ng/ml) toward the end of sperm cell differentiation, but decreased at spermiation. In females, plasma GTH I rose strongly for the first time up to early exogenous vitellogenesis, decreased during most exogenous vitellogenesis, and increased again around ovulation. Our data revealed that patterns of relative abundance of GTH Ibeta mRNA and pituitary and plasma GTH I were similar, but not the GTH II patterns, suggesting differential regulation between these two hormones at the transcriptional and posttranscriptional levels. Pituitary and plasma GH changes could not be related to sexual maturation, and only a weak relationship was observed between GH and gonadotropin patterns, demonstrating that no simple connection exists between somatotropic and gonadotropic axes at the pituitary level during gametogenesis.

Reduction of nosocomial infection in a neonatal intensive care unit (NICU)

New measures aimed at reducing nosocomial infection in our neonatal intensive care unit (NICU) were introduced over a 3-month period from 1 July to 30 September 1994.

OBJECTIVE

The aim of this study was to evaluate the impact of these measures on the incidence of nosocomial infection in our NICU.

METHODS

The new measures introduced were: 1. grouping of all blood investigations to allow for fewer blood samplings per baby per day; 2. reduction of routine blood investigations after the acute illness has stabilised, and 3. a system of aseptic delivery of drugs through a central venous catheter, thereby reducing the need for peripheral intravenous lines. Nosocomial infections were defined according to the criteria spelt out in the Centres for Disease Control (CDC) guidelines. Data for the study was obtained from the ongoing surveillance carried out by the hospital's infection control team. Period 1 (1 year duration) was prior to the implementation of the new measures. Period 2 (1 year duration) was after implementation of the new measures.

RESULTS

The overall nosocomial infection patient rates (expressed as number of infections per 100 intensive care unit patients) were 17.6 for Period 1 and 7.5 for Period 2. The overall nosocomial infection patient-day rates (expressed as number of infections per 1000 patient-days) were 13.5 and 6.1 respectively (p < 0.01). When the infants' birth weights were stratified as < 1500 g, 1500-2500 g, and > 2500 g, the greatest decline in both the overall nosocomial infection patient rate and nosocomial infection patient-day rate was seen in infants weighing < 1500 g. There was also a significant decline in the rates of blood-stream infections in infants weighing < 1500 g (from 7.5 to 2.8 per 1000 patient-days) (p < 0.05). Ventilator associated pneumonias also showed a decline from 3.3 to 1.0 pneumonia per 1000 ventilator days. The organisms responsible for the majority of blood stream infections in Period 1 were methicillin-resistant Staphylococci Aureus (MRSA), coagulase-negative staphylococci, gram-negative bacilli and candida. In Period 2, coagulase-negative staphylococci was the predominant organism.

CONCLUSION

We conclude that there was a reduction in nosocomial infection rates. The new measures introduced may have contributed to this reduction.

A retrospective study of infants with severe persistent pulmonary hypertension (PPHN) managed without extracorporeal membrane oxygenation (ECMO)

We studied 13 consecutive infants admitted to our Neonatal Intensive Care Unit over 37 months from 1 June 1994 to 30 June 1997, who were diagnosed with severe persistent pulmonary hypertension (PPHN) meeting extracorporeal membrane oxygenation (ECMO) criteria as defined by Bartlett and/or Short. They were managed with conservative ventilation strategy, with emphasis on the use of moderate ventilatory pressures whilst avoiding paralysis. Peak inspiratory pressure (PIP) on intermittent mandatory ventilation was adjusted according to adequate chest excursion. High PIP was avoided. Two main ventilatory techniques were used: 1) low ventilatory rate < or = 40/min, PIP 20 to 30 cmH2O, inspiratory time (IT) 0.5 seconds, positive end-expiratory pressure (PEEP) 5 cmH2O, and 2) high ventilatory rate 100/min, PEEP 0 cmH2O, IT 0.3 seconds. The aim was to keep preductal PaO2 > or = 50 mmHg. We did not sought to achieve alkalotic pH or low PaCO2. When PIP requirements exceeded 30 to 35 cmH2O, the use of an alternative rescue therapy such as pulmonary vasodilator, high frequency ventilation and/or surfactant were considered. Only 1 infant died of PPHN. Low mortality due to PPHN can be achieved using this strategy. There is a need for a randomised controlled trial to compare this strategy with other alternative treatment strategies.

Growth hormone receptors in testis and liver during the spermatogenetic cycle in rainbow trout (Oncorhynchus mykiss)

Changes in growth hormone (GH) receptivity in the testis during the reproductive cycle were studied in rainbow trout (Oncorhynchus mykiss). This necessitated setting up a method to characterize GH receptors (GH-R) in crude testis homogenate. Binding of radiolabeled recombinant rainbow trout GH (125I-rtGH) to crude testis preparation was dependent on testicular tissue concentration. The sites were specific to GH, with no affinity for prolactins, gonadotropins, or insulin. Similar high affinities for 125I-rtGH were obtained with crude testis (4.5 x 10(9) + 0.25 M(-1)) and crude liver preparations (5.1 x 10(9) +/- 0.06 M(-1)) at all stages of spermatogenesis, as well as with testicular membrane preparations (2.4 x 10(9) M(-1)). GH-R concentration in testis was high during the immature stage (590 fmol/g testis); it then decreased regularly from the beginning (stage II, spermatogonia proliferation: 706 fmol/g testis) to the end of spermatogenesis (stage VII: 158 fmol/g testis). Conversely, the absolute testicular capacity increased dramatically between stages IV and VI (1.2-16.2 pmol/2 gonads), when testicular growth is extremely rapid. GH-R concentration in the liver was highest in early stages (6.5-6.7 pmol/g liver); this value then significantly decreased during midspermatogenesis (stage VI: 3.5 pmol/g liver) and returned to immature levels at the end of the cycle. No significant correlation was found between GH-R in testis, GH-R in liver, and plasma GH concentration. Preliminary experiments performed on isolated populations of testicular cells revealed that binding of 125I-rtGH was detectable in Sertoli cell-enriched fractions but not in germ cell populations. We conclude that GH-R are present in the testis during the entire reproductive cycle in rainbow trout, probably in somatic cells and in particular in Sertoli cells.

Individual diurnal plasma profiles of thyroid hormones in rainbow trout (Oncorhynchus mykiss) in relation to cortisol, growth hormone, and growth rate

In order to characterize the individual diurnal plasma profiles of triiodothyronine (T3) and thyroxine (T4) in rainbow trout (Oncorhynchus mykiss), blood samples from 41 fish were taken every hour during a 24-hr period, through a catheter inserted into the dorsal aorta. The possible influences of day-night alternation, sex, and diet (feed intake, time of meals) on thyroid hormone (TH) profiles were analyzed. The existence of relations between diurnal plasma profiles of T3, T4, T3/T4 ratio, and those of the growth hormone (GH), cortisol (previously described in Gomez et al., J. Exp. Zool. 274, 171-180, 1996), and the growth rate was monitored. Average daily T3 and T4 concentrations were, respectively, 2.6 +/- 0.2 and 5.5 +/- 0.3 ng/ml (n = 41). Our study showed little or no variation in plasma T3 concentrations during one 24-hr period, while those of T4 fluctuated markedly. T4 peaks occurred from a baseline of 4.0 +/- 0.2 ng/ml at a frequency of 2.5 +/- 0.2 peaks/24 hr, with an amplitude of 3.0 +/- 0.4 ng/ml, and a duration of 4.3 +/- 0.4 hr. There was a significant difference between the average circulating T3 level during the day and that at night (2.4 +/- 0.2 vs 2.7 +/- 0.2 ng/ml). No influence of sex or food factors was observed on daily TH concentrations. TH peaks occurred irregularly and asynchronously without apparent influence of day-night alternation, sex, and diet. The growth rate was significantly correlated with the daily T3 concentration (r = 0.77), but not with T4. No significant relationships were found between daily concentrations of T3, T4, GH, and cortisol. The absence of a relationship between TH and GH concentrations suggests that, in salmonids, GH may have no observable short-term action on the conversion of T4 to T3.

Characterization of growth hormone nycthemeral plasma profiles in catheterized rainbow trout (Oncorhynchus mykiss)

This study was conducted in order to characterize the nycthemeral plasma profiles of growth hormone (GH) in 41 prepubertal (2+) rainbow trout (Oncorhynchus mykiss). The possible influences of day-night alternation and of the food factor (quantity ingested, timing of the feed) on these plasma profiles were also analysed. Blood samples were taken every hour during a 24-hour period through a catheter inserted in the dorsal aorta. An assay of cortisol levels showed that the fish were in satisfactory physiological condition. The plasma concentrations of GH fluctuated significantly during the course of a nycthemere. The basal level was very low (0.32 +/- 0.01 ng/ml), and was interrupted by peaks that occurred at a rate of 2.1 +/- 0.1 peaks/24 hr, an amplitude of 2.0 +/- 0.3 ng/ml, and a duration of 3.5 +/- 0.2 hr. As a result, mean GH levels over a 24-hr period were low (0.7 +/- 0.1 ng/ml). Peaks occurred irregularly and asynchronously in individual fish and displayed no rhythmicity. Our study shows that there is a sexual difference in GH profiles in rainbow trout. No significant difference was observed between daily and nightly levels of GH (0.6 +/- 0.07 vs. 0.8 +/- 0.1 ng/ml). No influence of the diet on the plasma profiles of GH was observed. Average levels of GH over a 24 hr period are not significantly correlated with the growth rate of the fish. This study shows that circulating levels of GH in rainbow trout are markedly lower than in other vertebrates.

Kaposi's sarcoma with an intense parasitization by Leishmania

Visceral leishmaniasis has been reported as a complication in patients infected with human immunodeficiency virus (HIV) who live in areas where leishmaniasis is endemic or in patients who have traveled to these areas. Kaposi's sarcoma has been found frequently in patients with acquired immunodeficiency syndrome (AIDS). We report a HIV-infected patient having visceral leishmaniasis associated with Kaposi's sarcoma in which a biopsy specimen obtained from a pigmented cutaneous lesion revealed the coexistence of a Kaposi's sarcoma pattern with Leishmania parasitic colonization.

Analysis of the association between chondrocalcinosis and osteoarthritis: a community based study

OBJECTIVES

To analyse the association between chondrocalcinosis and osteoarthritis (OA) of the hands and knees in an unselected elderly rural population.

METHODS

A community based cross sectional study was performed in individuals randomly selected from a previous epidemiological survey on the prevalence of chondrocalcinosis in people older than 60 years from Osona county, Catalonia, northeastern Spain. Radiological OA (grade 2 or more of Kellgren's classification) was evaluated in 26 individuals with chondrocalcinosis and in 104 controls. A total of 18 articular areas of both knees (medial and lateral tibiofemoral compartments) and hands (first, second and third metacarpophalangeal (MCP), first carpometacarpal, trapezium-scaphoid, radiocarpal and distal radioulnar joints) were studied.

RESULTS

Radiological changes of OA in the knees were more common in subjects with chondrocalcinosis than in those without it, with an odds ratio adjusted for age and gender (aOR) of 4.3 (95% confidence interval (CI) 1.6 to 11.8, p = 0.005). OA was also more frequent in almost all areas of the hands in individuals with chondrocalcinosis, though the difference reached statistical significance only in the MCP joints (aOR 3.1; 95% CI 1.1 to 8.8; p = 0.033). However, taking into account the side and the different joint compartments analysed, the association between chondrocalcinosis and OA was significant only in the lateral tibiofemoral compartment and the left MCP joints.

CONCLUSIONS

In an elderly population unselected for their rheumatic complaints, there was a real association between OA and chondrocalcinosis. This association was particularly relevant in the lateral tibiofemoral compartment of the knee and in the first three left MCP joints.

Salivary excretory pattern of testosterone in substitutive therapy with testosterone enanthate

OBJECTIVE

To determine salivary and serum T levels by an RIA method after a single injection of 250 mg IM of commercially available T enanthate.

DESIGN

Research study.

SETTING

Patients attended in a hospital environment.

PATIENTS

Sixteen men with secondary hypogonadism.

INTERVENTIONS

Testosterone enanthate was administered, and salivary samples were taken before the injection. Thereafter, these samples were obtained daily until day 7 and then on alternate days until day 28 after injection. Blood samples were taken previously and after the injection (5 samples during the month).

MAIN OUTCOME MEASURE

Salivary and serum T.

RESULTS

Salivary T levels rose from 3.46 +/- 3.16 to 13.82 +/- 7.78 ng/100 mL (0.12 +/- 0.11 to 0.48 +/- 0.27 nmol/L) within 24 hours and remained in that range until day 7. From day 9, 7.20 +/- 2.88 ng/100 mL (0.25 +/- 0.10 nmol/L), a progressive decrease of these values was observed until day 14: 5.18 +/- 2.88 ng/100 mL (0.18 +/- 0.10 nmol/L). From day 16 until day 28, salivary concentrations returned to hypogonadal levels.

CONCLUSION

We conclude that T salivary concentrations may be applied to assess the effectiveness of T substitutive therapy in hypogonadal men and could replace serum in the monitoring of this type of therapy.

Sonographic diagnosis of pylephlebitis in children

We present a case of inflammatory bowel disease in which the diagnosis of pylephlebitis was made by ultrasonography. The patient was treated with antibiotics and aspirin and had an uneventful recovery. The sonographic findings are described.

Survival prospects of extremely preterm infants: a 10-year experience in a single perinatal center

During a 10-year period, 1977 to 1986, 233 (53%) of 442 inborn live births between 23 and 28 weeks' gestation survived; their 1-year survival rate was 7% at 23 weeks, 30% at 24 weeks, 31% at 25 weeks, 55% at 26 weeks, 67% at 27 weeks, and 71% at 28 weeks. No significant change in survival rate was observed over the years. Twelve percent of pregnancies and 20% of infants were multiple gestations. Singleton births had significantly higher survival rates compared with multiple births (58% versus 41%). The obstetric intervention rate, as measured by the frequency of cesarean section, increased significantly over the years: from 15% in 1977-1978 to 33% in 1985-1986. The neonatal intervention rate, as measured by the frequency of live births offered neonatal intensive care, remained unchanged. Ten percent were not treated: 4% had major malformations and 6% were considered "nonviable." Active perinatal management, which assumed fetal-neonatal viability, accounted for better survival rates compared with centers with a more passive management policy. Information on survival based on gestational cohorts plays an important role in helping obstetricians, neonatologists, and parents make appropriate management decisions.

Duration of hospitalization in extremely preterm infants

This study reports the age at hospital discharge of 233 survivors and age at death of 209 infants who were born at 23-28 weeks gestation over a 10 year period, 1977-86. The mean duration of hospitalization of survivors was 95 days and was inversely related to maturity at birth; those born at 23-25 weeks remained in hospital on average 1-2 weeks beyond term while those born at 26-28 weeks went home on average at term or 1 week before term. The mean age at death was 12 days: 53% within 1 day, 23% between 2 and 7 days, 15% between 8 and 28 days and 9% between 28 days and 1 year. The proportions of death in the post-neonatal period for infants born at 23-24 weeks, 25-26 weeks and 27-28 weeks were 2, 9 and 16% respectively. There was no significant trend in prolonged hospitalization of survivors or postponement of neonatal deaths to the post-neonatal period over the 1977-86 period. Nevertheless, both neonatal and post-neonatal mortality should continually be monitored in this extremely preterm group.

Thyroid stimulating antibodies in patients with Graves' ophthalmopathy

The possible pathogenetic role of thyroid stimulating antibodies (TSAb) was studied in 24 patients. The TSAb were measured by their ability to stimulate concentration of cAMP in human thyroid slices incubated in vitro with the immunoglobulins of these patients. The patients were divided in two groups: Group I, 16 patients with eye disease and hyperthyroidism and Group II, eight patients with eye disease but without hyperthyroidism. TSAb, were found to be high in 15 patients of the Group I (3.22 +/- 1.74 pmol cAMP/mg of wet tissue, mean +/- S.E.M.) whilst were normal in six patients of the Group II (0.98 +/- 0.53 pmol cAMP/mg of wet tissue, mean S.E.M.) (p < 0.001). These findings indicate that TSAb is not a marker of the Graves' ophthalmopathy and support the concept that hyperthyroidism and exophthalmos are two separate disorders.

Evaluation of B-cell function in diabetics by C-peptide determination in basal and postprandial urine

Urinary C-peptide (UCP) values in basal and postprandial 2-hour samples are compared with simultaneous plasma C-peptide (PCP) values and with 24-hour UCP in 21 NIDDs, 24 IDDs and 9 controls. Basal and postprandial 2-h UCP was similar in controls and NIDDs (0.79 +/- 0.53 and 2.68 +/- 1.06 nmol/2 h versus 1.03 +/- 0.70 and 2.64 +/- 1.34, p greater than 0.05) and very low in IDDs (0.16 +/- 0.22 and 0.58 +/- 0.86, p less than 0.001). NIDDs showed basal (0.69 +/- 0.32 nmol/l) and postprandial (1.12 +/- 0.50) PCP values lower than controls (0.91 +/- 0.31 and 1.90 +/- 0.70). UCP clearance was higher in NIDDs than in controls. IDDs showed similar pattern of higher clearance but greater variability, the differences not being significant. It is concluded that despite correlations between PCP and UCP, possible differences can exist in C-peptide renal handling in diabetics, making unwise to use UCP as sole parameter of B-cell function in these patients.

A family with adult spinal and bulbar muscular atrophy, X-linked inheritance and associated testicular failure

A family with adult spinal and bulbar muscular atrophy with X-linked recessive inheritance (Kennedy's disease) is described. Affected members presented at age 20 with muscle cramps followed insidiously by gynaecomastia, partial loss of secondary sexual traits, loss of libido and inability to maintain an erection. Three had also testicular atrophy and severe oligospermia was found in two patients. Testicular biopsy in one case showed germinal failure with almost normal Leydig cells. Hormonal tests were suggestive of a primary testicular failure. Etiologic possibilities are considered.

[Islet cell antibodies in diabetic patients with other autoimmune diseases (author's transl)]

The presence of antibodies directed against pancreatic islet cells was investigated in 18 insulin pendent diabetic patients with autoimmune disease (Group 1), in 8 insulin-independent diabetic patients with autoimmune disease (Group 2), in 42 non-diabetic patients with thyroid antibodies (Group 3), in 18 patients with antibodies against gastric parietal cells (Group 4) and in 100 healthy subjects (controls). Islet cell antibodies were found in 46% of group 1 patients and in only 1 patient of group 3 and 1 control. This would suggest the existence of a special form of autoimmune insulin-dependent diabetes characterized by a high incidence of islet cell antibodies and associated with other autoimmune diseases.