Parapharyngeal cerebrospinal fluid collection: an unusual complication of temporal bone fracture.

OBJECTIVE: We present an unusual case of parapharyngeal cerebrospinal fluid collection causing upper airway obstruction following a temporal bone fracture. METHOD: Case report and literature review of temporal bone fracture associated with parapharyngeal cerebrospinal fluid collection. RESULTS: A 19-year-old man presented with cerebrospinal fluid otorrhoea and temporal bone fracture following a head injury. He was discharged after 48 hours of observation. The patient returned within 6 hours with sudden unilateral neck swelling and stridor after blowing his nose. Flexible nasendoscopy and computed tomography showed extrinsic compression of the pharynx, with partial upper airway obstruction. A literature review using Pubmed™ and Medline™ identified no previously reported cases of parapharyngeal cerebrospinal fluid collection associated with temporal bone fracture. CONCLUSION: This case illustrates a previously undescribed complication of temporal bone fracture. Raised intracranial pressure in the presence of a cerebrospinal fluid fistula may lead to airway obstruction, following temporal bone fracture.

COOH-terminal 26-amino acid residues of progastrin are sufficient for stimulation of mitosis in murine colonic epithelium in vivo.

Transgenic mice (hGAS) that overexpress human progastrin are more susceptible than wild-type mice (FVB/N) to the induction of colonic aberrant crypt foci (ACF) and adenomas by the chemical carcinogen azoxymethane. We have previously shown significantly increased levels of colonic mitosis in hGAS compared with FVB/N mice after gamma-radiation. To investigate whether the effects of progastrin observed in hGAS colon require the presence of other forms of circulating gastrin, we have crossed hGAS (hg(+/+)) with gastrin knockout (G(-/-)) mice to generate mice that express progastrin and no murine gastrin (G(-/-)hg(+/+)). After azoxymethane, G(-/-)hg(+/+) mice developed significantly more ACF than control G(-/-)hg(-/-) mice (which do not express any forms of gastrin). G(-/-)hg(+/+) mice also exhibited significantly increased colonic mitosis both before and after exposure to 8 Gray Gy gamma-radiation or 50 mg/kg azoxymethane compared with G(-/-)hg(-/-). Treatment of G(-/-)hg(-/-) mice with synthetic progastrin (residues 21-101 of human preprogastrin) or G17 extended at its COOH terminus corresponding to the COOH-terminal 26-amino-acid residues of human preprogastrin (residues 76-101, G17-CFP) resulted in continued colonic epithelial mitosis after gamma-radiation, whereas glycine-extended gastrin-17 and the COOH-terminal tryptic fragment of progastrin [human preprogastrin-(96-101)] had no effect. Immunoneutralization with an antibody against G17-CFP before gamma-radiation significantly decreased colonic mitosis in G(-/-)hg(+/+) mice to levels similar to G(-/-)hg(-/-). We conclude that progastrin does not require the presence of other forms of gastrin to exert proliferative effects on colonic epithelia and that the portion of the peptide responsible for these effects is contained within amino acid residues 76-101 of human preprogastrin.

Regulation of parietal cell migration by gastrin in the mouse.

Recent studies suggest that gastrin regulates parietal cell maturation. We asked whether it also regulates parietal cell life span and migration along the gland. Dividing cells were labeled with 5'-bromo-2'-deoxyuridine (BrdU), and parietal cells were identified by staining with Dolichos biflorus lectin. Cells positive for D. biflorus lectin and BrdU were reliably identified 10-30 days after BrdU injection in mice in which the gastrin gene had been deleted by homologous recombination (Gas-KO) and wild-type (C57BL/6) mice. The time course of labeling was similar in the two groups. The distribution of BrdU-labeled parietal cells in wild-type mice was consistent with migration to the base of the gland, but in Gas-KO mice, a higher proportion of BrdU-labeled cells was found more superficially 20 and 30 days after BrdU injection. Conversely, in transgenic mice overexpressing gastrin, BrdU-labeled parietal cells accounted for a higher proportion of the labeled pool in the base of the gland 10 days after BrdU injection. Gastrin, therefore, stimulates movement of parietal cells along the gland axis but does not influence their life span.

Meige syndrome secondary to basal ganglia injury: a potential cause of acute respiratory distress.

BACKGROUND: Meige syndrome is a movement disorder that includes blepharospasm and oromandibular dystonias. Its etiology may be idiopathic (primary) or it may arise secondary to focal brain injury. Acute respiratory distress as a feature of such dystonias occurs infrequently. A review of the literature on Meige syndrome and the relationship between dystonias and respiratory compromise is presented. METHODS: A 60-year-old woman suffered a cerebral anoxic event secondary to manual strangulation. She developed progressive blepharospasm combined with oromandibular and cervical dystonias. Neuroimaging demonstrated bilateral damage localized to the globus pallidus. Years later, she presented to the emergency department in intermittent respiratory distress associated with facial and cervical muscle spasms. RESULTS: Increasing frequency and severity of the disorder was noted over years. The acute onset of respiratory involvement required intubation and eventual tracheotomy. A partial therapeutic benefit of tetrabenazine was demonstrated. CONCLUSION: This case highlights two interesting aspects of Meige's syndrome: (1) Focal bilateral basal ganglia lesions appear to be responsible for this patient's movement disorder which is consistent with relative overactivity of the direct pathway from striatum to globus pallidus internal and substantia nigra pars reticularis; (2) Respiratory involvement in a primarily craniofacial dystonia to the point of acute airway compromise.

Promoting healthy behaviors in HIV primary care.

Recent treatment advances have prolonged the life expectancy of persons with human immunodeficiency virus (HIV). HIV care providers must now promote healthy behaviors, such as smoking cessation, exercise, and screening for general medical problems, such as diabetes and hyperlipidemia. This report describes recently published evidence and recommendations for providing HIV primary care.

Activated platelets adherent to an intact endothelial cell monolayer bind flowing neutrophils and enable them to transfer to the endothelial surface.

We have investigated the role that platelets may play in promoting adhesion of neutrophils to morphologically intact endothelium. Immortalized human microvascular endothelial cells (HMEC-1) were grown to confluence in a glass capillary (microslide) and incorporated in a flow-based assay that allowed video-microscopic quantitation of adhesive interactions of perfused, isolated neutrophils (wall shear rate 140 s(-1)). Platelets (with or without stimulation with thrombin) were first sedimented onto the HMEC-1 cells and formed discrete attachments covering <1% of the surface area. When neutrophils were perfused over the platelet-treated HMEC-1 cells, many short-lived adhesive interactions were seen (lasting approximately 0.3 seconds), whereas none were seen for monolayers without platelets. Few of these interactions converted to stationary adhesion, and only small numbers of neutrophils remained attached after a period of washout unless they were pre-stimulated with formyl peptide (fMLP; 10(-7) mol/L). Then about 30% of adhesive interactions by activated neutrophils were seen to transform to a stationary adhesion, and numerous adherent cells remained after a period of washout. Studies with function-blocking antibodies showed that capture of the neutrophils was dependent on P-selectin exposed on platelets. Initial immobilization was mediated predominantly by the beta2-integrin CD11b/CD18 expressed by neutrophils, but CD11a/CD18 also appeared to play a role in prolonged attachment. Visually, adhesion first occurred at sites occupied by platelets, but some activated neutrophils migrated onto the endothelial cells. These studies indicate that even small numbers of platelets that have adhered to morphologically intact endothelium have the potential to capture flowing neutrophils and facilitate their immobilization at the vessel wall and so promote inflammatory and thrombotic intercellular interactions.

The experience of relapse to unsafe sexual behavior among HIV-positive, heterosexual, minority men.

The purpose of this qualitative study was to examine the phenomenon of relapse to unsafe sexual behavior in human immunodeficiency virus (HIV)-positive, heterosexual, minority men. In-depth interviews were conducted by using a purposive sample of 18 HIV-positive, heterosexual, minority men who were recruited from an outpatient acquired immunodeficiency syndrome (AIDS) clinic in upstate New York and a community-based HIV/AIDS service organization in New York City. All participants expressed concern about the seriousness and health threat of unsafe sexual behaviors. The perceived benefits and barriers to unsafe sexual practices were identified. Content analysis revealed the following themes related to relapse to unsafe sexual behavior: drug and alcohol use, state of mind, "looking good" and "helping" fallacies, male-female relationship issues, influence of friends, weighing the risks, sexual preparation, uncontrollable sexual urges, and the symbolic meaning of condoms. Clinical implications related to health assessment, interventions, and health education and prevention programs for HIV-positive heterosexual, minority men and their sexual partners are presented.

Primary care and case management of persons with HIV/AIDS.

The nurse practitioner can meet the multiple needs of people living with HIV disease. Given the broad scope and integration of services required to care for clients with HIV/AIDS, the skill of a nursing case manager is also an integral part of the health care team. Together, these nursing clinicians can enhance the quality of care provided to HIV-infected individuals as each plays numerous roles with specific competencies and skills. This article discusses primary care services and the role of health care providers in working with persons with HIV/AIDS.

Alterations in basal protein kinase C activity modulate renal afferent arteriolar myogenic reactivity.

Myogenic vasoconstriction of the renal afferent arteriole contributes to the autoregulation of renal blood flow, glomerular filtration rate, and glomerular capillary pressure (PGC). The reactivity of the afferent arteriole to pressure and the efficiency of PGC control are subject to physiological and pathophysiological alterations, but the determinants of the myogenic response of this vessel are largely unknown. We used the in vitro perfused hydronephrotic rat kidney to investigate the role of protein kinase C (PKC) in the control of this response. Inhibition of PKC by 1 microM chelerythrine attenuated myogenic reactivity but did not affect the afferent arteriole vasoconstrictor response to KCl (35 mM)-induced depolarization. Low concentrations of phorbol ester (10 nM phorbol 12-myristate 13-acetate) and low levels of ANG II or endothelin-1 (3 pM) potentiated myogenic vasoconstriction without affecting basal afferent arteriolar diameters. These actions were blocked by 1 microM chelerythrine, suggesting a PKC-dependent mechanism. Finally, although PKC inhibition attenuated basal myogenic responses, full reactivity to pressure was restored by 1 mM 4-aminopyridine, a pharmacological inhibitor of delayed rectifier K channels, which are known to be modulated by PKC. The ability of 4-aminopyridine to circumvent the effects of PKC inhibition militates against a direct role of PKC in myogenic signaling. We interpret these observations as indicating that basal PKC activity is an important determinant of myogenic reactivity in the renal afferent arteriole. However, PKC activation does not appear to play an obligate role in myogenic signaling in this vessel. We suggest that basal PKC activity directly modulates voltage-gated K channel activity, thereby indirectly affecting myogenic reactivity.

Hazardous terrain and over the edge: the survival of HIV-positive heterosexual, minority men.

The purpose of this study was to describe and explore the experience and perceptions of heterosexual minority men living with and surviving HIV infection. This descriptive, exploratory qualitative study used in-depth interviews that were guided by Rosenstock's health belief model and Ajzen's theory of planned behavior. A purposive sample of 18 HIV-positive heterosexual, minority men were accrued from an outpatient HIV/AIDS clinic in upstate New York and a community-based AIDS service organization in New York City. The findings revealed that the experience of surviving HIV infection encompassed several stages. The men of this study described the choices they made in adolescence that led them down a trail of life that may be metaphorically described as "hazardous terrain," as the majority became involved in substance use or other illicit activities. With the diagnosis of HIV infection came a "Falling Off" stage, in which the participants went "over the edge" and initially were afraid to die but realized at this point that they were okay but vulnerable. The next stage was "Hanging On," in which they attempted to gain control, reevaluated priorities, and developed a new perspective on life and health. In the "Pulling Up" stage, participants realized that the rescue team included self, God, family, and friends, with self-rescue occurring on emotional, physical, and spiritual levels. As the participants reached the "Turning Around" stage, they began to accept responsibility for their health, focused on their abilities rather than their limitations, and reframed their perspectives to living with rather than dying from HIV infection. This study has implications for health-education programs, AIDS prevention, health assessment, and interventions for HIV-positive, heterosexual, minority men.