Caso atípico de edema agudo de pulmón en el postparto no inmediato / Atypical case of cute pulmonary edema in non-immediate postpartum

Describimos el caso de una mujer joven sin antecedentes previos de interés, que tras su 5º parto vía vaginal y que transcurrió sin incidencias tanto el embarazo como el parto, ingresa 1 semana después por un cuadro de edema agudo de pulmón con insuficiencia respiratoria hipoxémica severa secundaria y datos de hipertensión arterial pulmonar, muy bien toleradoclínicamente y autolimitado. Discutimos los posibles diagnósticos diferenciales del edema agudo pulmonar postparto y en relación con su fisiopatología las posibles causas que justificaran nuestro caso, sin etiología evidente tras los estudios realizados. Anuestro conocimiento tras revisión de la literatura es un caso excepcional la situación de edema agudo de pulmón con hipertensión arterial pulmonar en el postparto no inmediato, y autolimitado

We describe the case of a young woman with no previous background of interest who one week after after her 5th vaginal delivery and having had a pregnancy and delivery with no incidences was admitted to hospital due to an acute pulmonary edema picture with severe secondary hypoxemic respiratory failure and data of pulmonary arterial hypertension, that was very well tolerated clinically and was self-limited. We discuss the possible differential diagnoses of acute postpartum pulmonary edema and, regarding its pathophysiology, the possible causes that would justify our case,with no clear etiology after the studies conducted. To our knowledge, after the review of the literature, the situation of acute pulmonary edema with pulmonary arterial hypertension in the non-immediate postpartum that is self-limited is a rare case26183

A pilot study of a thiazolidinedione, troglitazone, in nonalcoholic steatohepatitis.

OBJECTIVES: Troglitazone is a thiazolidinedione and peroxisome proliferator-activated receptor gamma (PPARgamma) ligand used to treat diabetes mellitus type II. Because hyperinsulinemia may be a factor in nonalcoholic steatohepatitis (NASH), we postulated that troglitazone could have beneficial effects in this disorder. Our study was initiated before reports of idiosyncratic hepatitis induced by this agent and was completed before its recent withdrawal from the market. METHODS: We studied 10 female patients (age 44 +/- 16) with histological NASH. All but two were obese (mean body mass index, BMI = 38 +/- 6). One had type 2 diabetes, and three had well-compensated cirrhosis with NASH. Troglitazone was given at a dose of 400 mg/day for < or = 6 months. Responders (defined as normal ALT at the end of treatment) were rebiopsied. Paired specimens were compared in blinded fashion. Mitochondria were quantitated using ultrathin electron microscopy. RESULTS: Seven of ten patients responded with normal ALT at the end of treatment. One of three nonresponders initially normalized ALT but returned to pretreatment level at 3 months. In this patient, therapy was stopped, and the ALT has remained at the baseline level with no other clinical or laboratory findings. In the responders, ALT fell from 87 +/- 38 before to 39 +/- 9 at the end of treatment (p = 0.01), and AST decreased from 77 +/- 23 to 30 +/- 8 (p = 0.002). Biopsy comparisons before and after therapy showed persistent steatohepatitis in all cases, although four of seven showed a one-point improvement in the necroinflammatory grade. Electron microscopy revealed elongation of the mitochondria after therapy. CONCLUSIONS: Normal ALT was seen in 70% of NASH patients at the end of treatment, but this biochemical response was associated with only mild histological improvement, and all follow-up biopsies had evidence of NASH. Normalization of the liver enzymes in patients with NASH who are treated with thiazolidinediones should be viewed with reservation. Follow-up biopsy is essential to evaluate the efficacy of these agents, which, at the histological level, appears to be relatively modest.

Functional properties of transfected human DMT1 iron transporter.

Recently, mutation of the DMT1 gene has been discovered to cause ineffective intestinal iron uptake and abnormal body iron metabolism in the anemic Belgrade rat and mk mouse. DMT1 transports first-series transition metals, but only iron turns on an inward proton current. The process of iron transport was studied by transfection of human DMT1 into the COS-7 cell line. Native and epitope-tagged human DMT1 led to increased iron uptake. The human gene with the Belgrade rat mutation was found to have one-fifth of the activity of the wild-type protein. The pH optimum of human DMT1 iron uptake was 6.75, which is equivalent to the pH of the duodenal brush border. The transporter demonstrates uptake without saturation from 0 to 50 microM iron, recapitulating earlier studies of isolated intestinal enterocytes. Diethylpyrocarbonate inhibition of iron uptake in DMT1-transfected cells suggests a functional role for histidine residues. Finally, a model is presented that incorporates the selectivity of the DMT1 transporter for transition metals and a potential role for the inward proton current.

Cryptogenic cirrhosis: clinical characterization and risk factors for underlying disease.

We characterized 70 consecutive patients with cryptogenic cirrhosis to assess major risks for liver disease. Each patient was reevaluated for past alcohol exposure, scored by the International Autoimmune Hepatitis (IAH) score and assessed for viral hepatitis risks and risks for nonalcoholic steatohepatitis (NASH). The results were compared with 50 consecutive NASH patients, 39 nonalcoholic patients age 50 and over with cirrhosis from hepatitis C, and 33 consecutive patients with cirrhosis caused by primary biliary cirrhosis (PBC). Among the cryptogenic group, 49 (70%) were female, and the mean age was 63 +/- 11 years. Although ascites and variceal bleeding were common, almost one half lacked major signs of complicated portal hypertension. A history of Type 2 diabetes mellitus and/or obesity was present in 51 (73%). Nineteen (27%) patients had a history of blood transfusions antedating the diagnosis of cirrhosis. No clinical or histological features distinguished this group from the other patients, and 14 (74%) of these had a history of obesity and/or diabetes. Nineteen of the remaining nontransfused patients had indeterminant IAH scores but were histologically and biochemically indistinguishable from the others. Twelve of these (63%) also had a history of obesity and/or diabetes. Both diabetes and obesity were significantly more common in the cryptogenic cirrhotic patients compared with the cirrhotic patients with PBC or hepatitis C. In contrast, the prevalence of obesity and diabetes was similar to the NASH patients who were, on average, a decade younger. Although there is some diversity that indicates more than one cause, our findings suggest that NASH plays an under-recognized role in many patients with cryptogenic cirrhosis, most of whom are older, type 2 diabetic and obese females.

Confronting a rising tide of eating disorders and obesity: treatment vs. prevention and policy.

Eating disorders and obesity are rising in prevalence and are problems of considerable public health significance. Prevailing treatments have a limited impact on public health because the disorders do not yield easily to intervention and because the treatments are costly and available to few. Shifting from a medical to a public health model argues for increased focus on both prevention and public policy. Research on prevention is in its early stages but must be aggressively pursued. Even less is known about policy, but recommendations are made to alter policy so that consumption of healthful foods increases, consumption of unhealthful foods decreases, and levels of physical activity are enhanced.

Three cases of hemorrhagic colitis in West Virginia due to Escherichia coli O157:H7.

Escherichia coli O157:H7 is an emerging cause of food-borne illness. This bacterial pathogen, most commonly transmitted by undercooked ground beef, causes hemorrhagic colitis. It has been associated with the hemolytic uremic syndrome and death, mostly in children and the elderly. This article describes three patients treated for sporadic cases of Escherichia coli O157:H7-associated hemorrhagic colitis at Charleston Area Medical Center over a three-week period.

Role of epithelial-mesenchymal interactions in the differentiation and spatial organization of visceral smooth muscle.

Uterine mesenchyme from newborn (0-day) rats was grown in association with epithelia from the adult cornea, urinary bladder, oesophagus, mammary gland, 1-day skin, and 1-day uterus. Following 1 month of growth, the differentiation of uterine mesenchyme into actin-positive smooth muscle cells was assessed immunocytochemically with antibodies to smooth muscle actin. Whereas grafts of uterine mesenchyme produced only small amounts of myometrium, all types of epithelia induced extensive myometrial differentiation in the uterine mesenchyme, which indicates that this effect is non-specific. The role of cell-cell interactions in the morphological patterning of smooth muscle layers was assessed by analysing tissue recombinants composed of adult prostatic epithelium (PRE) plus mesenchyme of the urogenital sinus (UGM), or seminal vesicle (SVM), or adult bladder epithelium (BLE) plus UGM or SVM. Prostatic ducts developed in all of these tissue recombinants (UGM + BLE, SVM + BLE, UGM + PRE and SVM + PRE). When UGM was used (UGM + PRE and UGM + BLE recombinants), actin-positive smooth muscle cells became organized into thin sheaths resembling the prostatic pattern. Conversely, when SVM was grown in association with PRE or BLE, the induced prostatic ducts were surrounded by thick layers of smooth muscle cells exhibiting the seminal vesicle pattern of organization. Smooth muscle cells were unorganized in grafts of SVM or UGM alone. These observations suggest that in male urogenital glands the mesenchyme dictates the spatial organization of the smooth muscle layers.(ABSTRACT TRUNCATED AT 250 WORDS)

The germ layer origin of mouse vaginal epithelium restricts its responsiveness to mesenchymal inductors: uterine induction.

The epithelium of the mammalian vagina arises from two distinct germ layers, endoderm from the urogenital sinus and mesoderm from the lower fused Müllerian ducts. While previously it has been reported that neonatal vaginal epithelium can be induced to differentiate as uterus, which normally develops from the middle portion of the Müllerian ducts, it has not been determined whether this ability is shared by both mesoderm- and endoderm-derived vaginal epithelia. To test if germ layer origin influences the ability of vaginal epithelium to undergo uterine differentiation, we have isolated sinus-derived and Müllerian-derived vaginal epithelia from newborn mice, combined them with uterine mesenchyme, and grown them for 4 weeks in female mice. Mesoderm-derived Müllerian vaginal epithelium in combination with uterine mesenchyme formed the simple columnar epithelium typical of uterus. Similar results were obtained with neonatal cervical epithelium, another mesodermal Müllerian duct derivative. On the other hand, sinus vaginal epithelium combined with uterine mesenchyme formed small cysts lined by a stratified squamous vaginal-like epithelium. This epithelium never showed evidence of cycling between the cornified and mucified states as is typically seen in vaginal epithelium combined with vaginal stroma. These results indicate that the ability of epithelium to form uterus is limited to mesoderm-derived epithelia and suggest that endoderm-derived sinus vaginal epithelium cannot undergo the typical differentiative modifications in response to the hormonal fluctuations of the estrous cycle when associated with uterine stroma.

The response of female urogenital tract epithelia to mesenchymal inductors is restricted by the germ layer origin of the epithelium: prostatic inductions.

The epithelium of the mammalian vagina arises from two distinct germ layers, endoderm from the urogenital sinus and mesoderm from the Müllerian ducts. While neonatal vaginal epithelium can be induced to form prostate which is normally an endodermal derivative, it has not been determined whether this ability to form prostate is shared by both mesoderm- and endoderm-derived vaginal epithelia. To test the competence of vaginal epithelia we have isolated sinus-derived and Müllerian-derived vaginal epithelia from newborn mice, combined them with rat urogenital sinus mesenchyme, and grown the tissue recombinants for 4 weeks in male athymic nude mice. Endoderm-derived sinus vaginal epithelium was induced to form prostatic tissue which expressed prostate-specific secretory proteins in 21 of 23 tissue recombinants. Müllerian-derived vaginal epithelium formed small ducts and cysts lined by a simple epithelium. These latter tissue recombinants lacked any evidence of prostatic secretory proteins. Similarly, endoderm-derived urethral epithelium was induced to form prostate (17 of 17 cases), while mesoderm-derived uterine epithelium was not (0 of 13 cases). Therefore, the ability to form prostatic epithelium was limited to endodermal derivatives of the urogenital tract.

Characteristics of well adjusted adolescents.

In a community sample of 150 adolescents 14-16 years old, 25 (16.7%) were found to be well adjusted on the basis of structured interviews with the youths and their parents. The personalities of these subjects were found to be different and their self-concepts better than those of the remaining sample. The well adjusted adolescents described their parents as more caring and reported a larger number of social support systems than did the controls. The direct significance of these findings, as well as more subtle ramifications for the mental health professional, is discussed.

Productive employee interviewing. Methods for choosing OR staff.

The hiring interview is a widely used method of identifying qualified applicants to fill the needs of an organization. Careful planning and organizing before the applicant arrives can minimize the risks of gaps in information and poor impressions of the institution. One-to-one or panel interviewing can be conducted, but using structured questions and scoring in a consistent manner are essential for validity. Questions should be job-related and standardized. Scoring the responses to questions provides a mechanism for evaluation and comparison. To enhance the interview process, attention should be given to the overall environment and initial greeting of the applicant. Listening to implicit as well as explicit messages helps the interviewer develop opinions and impressions that can be explored by further discussion or additional questions. Assessment of skills, knowledge, motivation, and personality traits provides a composite of applicant potential and suitability. Although it may not offer a 100% guarantee of success, interviewing can be a rewarding experience for both you and the applicant.

Developing a rating interview guide.

Nursing administrators have spent considerable time and effort developing various interview tools that will meet the needs of the institution, however, of equal importance is the method of evaluating responses obtained during the interview process. This article discusses a master tool designed as a base from which a variety of interview tools can be developed. Weighted scoring reflects the strengths of the applicant consistent with the position requirements and in an equitable manner.