Kidney stones as a manifestation of hypercalcemic disorders. Hyperparathyroidism and sarcoidosis.

When hypercalcemia is detected in a kidney stone formation, an intact parathyroid hormone measurement should be made. Detection of hyperparathyroidism (HPT) is important to prevent further stone episodes and to avoid the complications of high serum calcium in other organ systems. Stones in patients with HPT often contain apatite salts in addition to calcium oxalate because parathyroid excess may create a renal tubular acidosis. The calculi seen in patients with sarcoidosis, another hypercalcemic state that may cause stone formation, however, are usually pure calcium oxalate. Excess generation of 1,25-dihydroxyvitamin D results in intestinal hyperabsorption of calcium and secondary hyperoxaluria.

Preventive health care among rural American Indians in New Mexico.

BACKGROUND: Incidence of and mortality from cardiovascular disease, cancer, diabetes, and other chronic diseases are rapidly increasing among American Indians; however, the utilization of preventive services for these conditions is not well characterized in these ethnic groups. METHODS: We interviewed 1,273 American Indian adults in New Mexico, ages 18 years and older, by telephone regarding routine health checks, including blood pressure, blood cholesterol, mammograms, clinical breast exams, Pap smears, influenza and pneumonia vaccinations, and diabetes using items from the CDC Behavioral Risk Factor Surveillance System. RESULTS: We found that utilization of preventive service was surprisingly high among rural American Indians. Routine health checks and blood pressure checks within the past year were reported by more than 70% of the population. Blood cholesterol checks (41.1%) and pneumonia vaccinations (30.7%) were less commonly reported. Utilization of cancer screening for the most common women's cancers was also high. Most women reported ever having a Pap smear test (88.3%), a clinical breast examination (79.5%), and a mammogram (75.6%). The prevalence of diagnosed diabetes (8.8% overall and 26.4% for ages 50 years and older) greatly exceeds the nationwide prevalence. CONCLUSIONS: The utilization of preventive services delivered by a unique governmental partnership is high among American Indians in New Mexico and, except for cholesterol screening, is comparable with rates for the U.S. population. Because cardiovascular disease is on the rise, more attention to preventive services in this arena is warranted. The high and increasing prevalence of diagnosed diabetes suggests that aggressive diabetes screening and interventions are needed.

Evidence for a significant correlation of donor pancreas morphology and the yield of isolated purified human islets.

In clinical islet transplantation to patients with type 1 diabetes mellitus, the number of isolated and purified islet has been identified as a key determinant for functional success of the islet graft. With improved isolation methods based on the original procedure published by Ricordi et al. yield and function of isolated islets were considerably enhanced. However, there is still a large variance in the number, purity, viability and secretory capacity of islets isolated from brain-dead human donor pancreata, significantly hampering utilization of human islet preparations derived from a single donor for one diabetic recipient. The reasons for the limited success in islet isolation and purification have not been clarified in detail yet. Recent studies have indicated, that donor preconditions, and a number of technical factors during organ procurement and the islet isolation process itself are critical to successful islet isolation. This study aimed at identifying distinct morphological and histopathological characteristics of the donor pancreas as determinants for the outcome of human islet isolation and purification.

Health-related quality of life for rural American Indians in New Mexico.

OBJECTIVES: To determine health-related quality of life for rural American Indians using an economical telephone surveillance system. DESIGN: We interviewed 618 American Indians by telephone about health-related quality of life using an adaptation of the Behavioral Risk Factor Surveillance System questionnaire. RESULTS: A smaller proportion of rural New Mexico American Indians (50.7%) reported their general health as 'excellent' or 'very good' compared to the overall New Mexico (58.2%) and US populations (57.9%). American Indians reported a mental health limitation more frequently than the New Mexico and the US populations. However, 13% fewer rural New Mexico American Indians reported a limitation in usual activities. Most limitations were due to musculoskeletal conditions or diabetes mellitus. Survey respondents were found to be representative of the rural American Indian population as reported by the 1990 US Census Bureau by tribal group affiliation and age, but were not representative by income, education, and gender. CONCLUSIONS: Health-related quality of life for rural American Indians differs little from that of other New Mexicans and the general US population; however, when physical and mental health was rated as poor, fewer American Indians reported a limitation in usual activities. A telephone survey focusing on New Mexico American Indians is an efficient method by which to conduct surveillance of health-related quality of life.

Effects of autonomic neuropathy on counterregulation and awareness of hypoglycemia in type 1 diabetic patients.

OBJECTIVE: The recent EURODIAB Study has identified autonomic neuropathy as an independent risk factor for severe hypoglycemia in patients with type 1 diabetes. We tested the hypothesis that counterregulatory catecholamine responses and awareness of hypoglycemia are impaired to a greater extent in type 1 diabetic patients with autonomic neuropathy (AN+) than in those without autonomic neuropathy (AN-). RESEARCH DESIGN AND METHODS: We studied 22 type 1 diabetic patients (8 AN+, 14 AN-) matched for age, duration of diabetes, glycemic control, and history of hypoglycemic episodes. We also studied 33 nondiabetic control subjects using the stepped hypoglycemic clamp technique and determined glycemic thresholds and magnitudes of counterregulatory hormone responses and of hypoglycemia symptoms. RESULTS: Both groups of diabetic patients had reduced awareness of hypoglycemia as evidenced by an elevated glycemic threshold for autonomic symptoms > or =2 SD above normal but neither the magnitude nor thresholds for symptoms differed in AN+ patients and AN-patients. Both groups also had impaired glucagon, epinephrine, norepinephrine, growth hormone and cortisol responses to hypoglycemia. However, in AN+ patients compared with AN-patients, magnitudes of epinephrine and norepinephrine responses (194+/-49 vs. 784+/-206 pmol/l, P < 0.007, and 316+/-56 vs. 610+/-87 pmol/l, P < 0.02, respectively) and epinephrine and norepinephrine glycemic thresholds (2.33+/- 0.10 vs. 2.82+/-0.10 mmol/l, P < 0.009 and 2.34+/-0.06 vs. 2.79+/-0.10 mmol/l, P < 0.008, respectively) were impaired to a greater extent. This was associated with a 50% greater requirement of exogenous glucose to prevent more severe hypoglycemia during the 2.3 mmol/l glycemic plateau (P < 0.002). No differences were observed between other counterregulatory hormone responses in AN+ and AN- patients. CONCLUSIONS: We conclude that in patients with type 1 diabetes, autonomic neuropathy further reduces counterregulatory catecholamine responses. Since this should increase the risk for severe hypoglycemia, one might consider safer therapeutic goals in these patients.

Non-ceremonial tobacco use among southwestern rural American Indians: the New Mexico American Indian Behavioural Risk Factor Survey.

OBJECTIVES: To ascertain non-ceremonial tobacco use among rural American Indians in New Mexico (United States). DESIGN: A geographically targeted telephone survey. SETTING: Rural New Mexico. PARTICIPANTS: American Indian residents aged 18 years and older. MAIN OUTCOME MEASURES: Prevalence of ever-smokers and current smokers of cigarettes and ever-users and current users of smokeless tobacco, number of cigarettes smoked, and prevalence of cigarette smoking quitting behaviour. RESULTS: Of the 1266 respondents, 38.5% (95% confidence interval (CI) = 34.5% to 42.1%) reported ever smoking, and 16.3% (95% CI = 13.5% to 19.0%) reported being current smokers. Current smokers averaged 7.6 (95% CI = 6.0 to 9.3) cigarettes per day. Current smoking prevalence was highest among men and lowest among college graduates. Prevalence of smokeless tobacco use was 24.1% for ever-use and 7.2% for current use and showed a strong male predominance of use. CONCLUSIONS: The prevalence of current smokers among rural American Indians in New Mexico was lower than among American Indians of other regions in the United States, all New Mexicans, and the national population as a whole. Although smoking prevalence was lower among American Indians in New Mexico, variation by sex and education followed the same patterns as reported among American Indians of other regions.

A three-dimensional photographic method for documentation and measurement of dental conditions.

A 3-D photographic technique was developed for the registration of bite conditions. This technique may replace plaster models for archiving purposes. To achieve this, photographic equipment and computer programs should be user friendly, not too expensive, and allow measurements that satisfy scientific demands. This purpose was fulfilled by combining the following elements: a photographic unit with standardized conditions for 3-D photography and a reference object with known coordinates where bite impressions or models are placed during photography. To reconstruct 3-D coordinates from photographs these are placed on a digitizer connected to a computer programmed for reconstructing 3-D coordinates from the digitized 2-D data. The accuracy of the 3-D reconstruction of coordinates, x, y, z, was tested by means of 3-D photographs of a test object with reference points having a precision of +/- 0.5 micron. The mean error for distances of 5 mm and 15 mm varied between -0.17 mm and +0.15 mm. Measurements of 45 degrees and 90 degrees angles had an accuracy that varied from -0.5 degree to +0.9 degree and from -1.2 degrees to +1.5 degrees respectively. An angle between lines and a plane of 54.7 degrees displayed a mean error of +/- 1.6 degrees. The test of the accuracy of the 3-D photographic technique for calculating distances and angles demonstrated that it fulfills demands for scientific applications on clinical material.

Metformin: actions and indications for use in non-insulin-dependent diabetes mellitus.

Metformin (N,N-dimethylbiguanide) is about to be introduced into the United States. The drug, a potent blood glucose-lowering agent, is rapidly absorbed through the small intestine, has a circulating t 1/2 in plasma of 1.7 to 2.5 hours, and is 90% cleared through the kidneys in 12 hours. The drug does not cause hypoglycemia in nondiabetic patients and is effective in both obese and nonobese patients with non-insulin-dependent diabetes mellitus (NIDDM). The drug does not act through stimulation of endogenous insulin secretion. It seems to act at multiple sites, with a small effect on the inhibition of intestinal glucose transport, a moderate effect on inhibition of hepatic glucose output, and a major effect on enhancement of peripheral glucose uptake by muscle and adipose tissues. In addition to its glucose-lowering potency, metformin causes weight loss in obese patients with NIDDM and lowers total cholesterol, very-low-density lipoprotein cholesterol, total triglycerides, and very-low-density lipoprotein triglyceride levels as well as causing an increase in high-density lipoprotein cholesterol level. The drug is ideally suited for obese patients with NIDDM who are unresponsive to diet alone, and it is effective in combination with sulfonylureas. The major risk associated with use of metformin is the development of lactic acidosis. Patients predisposed toward the development of lactic acidosis are those with hepatic or renal disease or with tissue ischemia, in whom the drug should not be prescribed.

Color coding of radiographic changes over time by means of image addition.

Differences between sequential radiographs may be displayed in color if the individual radiographs are transformed into monochromatic images and then added. Information in regions where the radiographs are identical is retained whereas differences are emphasized by the color coding that comes about in a quantitative manner from the gray level values in the sequence of radiographs. By using the three additive primary colors, red, blue, and green, two or three radiographs from a sequence may be added. Every possible state of a bone disease, progression, regression, or any combination, will produce a different and specific color code. Different development cycles are described, and the color coding that appears when color image addition is performed is analyzed. The color addition technique should constitute a useful substitute or alternative to subtraction.

Arterial infections due to Listeria monocytogenes: report of four cases and review of world literature.

Early diagnosis and successful antimicrobial therapy have diminished the frequency of embolomycotic aneurysms, but infected aortic and small vessel aneurysms, arteriosclerotic plaques, and prosthetic grafts are becoming more common. A broad spectrum of pathogens, including Staphylococcus, Salmonella, Enterobacteriaceae, Pseudomonas aeruginosa, and some unusual organisms, are associated with this change. We treated four patients (three with abdominal aortic aneurysms and one with a prosthetic graft) with arterial infections caused by Listeria monocytogenes. Only seven other cases have previously been recorded in the world literature. Infection is suspected when a palpable or radiographically defined aneurysm is present with an otherwise obscure febrile illness. In about one-third of patients, blood cultures have yielded the pathogen. Newer imaging techniques have helped confirm the diagnosis. These infections are best managed by surgical resection in combination with long-term, appropriate antimicrobial therapy with ampicillin or sulfonamides. Unlike other adult listerial infection, except endocarditis, in arterial infection, immunosuppression and malignancy are not predisposing factors.

Diabetes is associated with a high incidence of endothelial-binding antibodies which do not correlate with retinopathy, von Willebrand factor, angiotensin-converting enzyme or C-reactive protein.

Increasing evidence implicates endothelial cell dysfunction in the development of diabetic microvascular disease, but its precise nature is elusive. This study sought to extend previous observations on the association between diabetes and the endothelial cell-derived glycoprotein von Willebrand factor (vWF), in a study of 777 diabetic patients. Compared with a mean of 1.07 +/- 0.18 iu/ml in a non-diabetic population, vWF was found to be elevated to 1.59 +/- 0.14 iu/ml in the whole sample, but particularly in those with retinopathy or microalbuminuria. It was studied whether such an elevation is part of an acute phase response, or is accompanied by other indicators of endothelial cell dysfunction. Plasma samples were examined for vWF, and serum for angiotensin converting enzyme (ACE), C-Reactive protein (CRP), IgG and IgM endothelial cell-binding antibodies (anti-EC Ig). A strong positive association was found (p less than 0.005) between the extent of elevation of vWF and the presence of diabetic retinopathy. ACE and CRP were rarely raised, and their levels did not correlate with either diabetic retinopathy or vWF levels. However, 52% of the patients had circulating anti-EC IgG or IgM, although their presence did not correlate with retinopathy, or with vWF, ACE or CRP. Thus diabetic retinopathy and probably nephropathy is associated with a specific but generalised disturbance of vascular endothelial cell function.(ABSTRACT TRUNCATED AT 250 WORDS)