Reversible right-sided congestive heart failure secondary to primary hyperaldosteronism in a cat.

A 10-year-old male castrated Somali cat presented with neurologic signs, severe systemic hypertension, and hypokalemia. Abdominal ultrasonography demonstrated a left adrenal mass, and the serum aldosterone concentration was increased. Computed tomography and follow-up diagnostic testing confirmed a left adrenal mass consistent with functional adenocarcinoma; additional findings included chronic airway and parenchymal disease. Transthoracic echocardiography revealed biatrial enlargement, with abdominal and pericardial effusion, consistent with right-sided congestive heart failure. The cat was treated for congestive heart failure and adrenalectomy was performed. Cardiac structure and function returned to normal within 6 months postoperatively. This report highlights a case of reversible congestive heart failure secondary to primary hyperaldosteronism.

Variation in access to sugar-sweetened beverages in vending machines across rural, town and urban high schools.

OBJECTIVES: The 2010 Dietary Guidelines for Americans include reducing consumption of sugar-sweetened beverages. Among the many possible routes of access for youth, school vending machines provide ready availability of sugar-sweetened beverages. The purpose of this study was to determine variation in high school student access to sugar-sweetened beverages through vending machines by geographic location - urban, town or rural - and to offer an approach for analysing school vending machine content. STUDY DESIGN: Cross-sectional observational study. METHODS: Between October 2007 and May 2008, trained coders recorded beverage vending machine content and machine-front advertising in 113 machines across 26 schools in New Hampshire and Vermont, USA. RESULTS: Compared with town schools, urban schools were significantly less likely to offer sugar-sweetened beverages (P = 0.002). Rural schools also offered more sugar-sweetened beverages than urban schools, but this difference was not significant. Advertisements for sugar-sweetened beverages were highly prevalent in town schools. CONCLUSIONS: High school students have ready access to sugar-sweetened beverages through their school vending machines. Town schools offer the highest risk of exposure; school vending machines located in towns offer up to twice as much access to sugar-sweetened beverages in both content and advertising compared with urban locations. Variation by geographic region suggests that healthier environments are possible and some schools can lead as inspirational role models.

Vasopressin as an etiologic factor for infection in gynecologic surgery: a randomized double-blind placebo-controlled trial.

OBJECTIVE: The purpose of this study was to evaluate the risk of pelvic infection with the use of vasopressin at time of vaginal hysterectomy with a randomized controlled trial. STUDY DESIGN: Women who underwent vaginal hysterectomy and agreed to participate were randomly assigned to pericervical injections of vasopressin or normal saline solution. Surgeons and patients were blinded to the injected substance. Power analysis revealed that a sample size of 116 patients would be sufficient to detect a 4-fold difference in pelvic infection rates between the 2 groups, with 90% power and a probability value of.05. RESULTS: Analysis with 117 patients found no difference in infection rate between the normal saline solution group and the vasopressin groups (7.3% vs 1.6%; P =.19). Estimated blood loss (312 +/- 222 mL vs 446 +/- 296 mL; P =.006) and change in hemoglobin and hematocrit levels (2.1 +/- 1.4 gm vs 2.9 +/- 1.4 gm; P: =.02; and 6.7% +/- 3.4% vs 8.5% +/- 3.8%; P =.01; vasopressin versus normal saline solution, respectively) were significantly less in the vasopressin group. There were no significant differences in interval blood pressure measurements after vasopressin administration between the 2 groups. CONCLUSION: The use of vasopressin during vaginal hysterectomy does not increase the risk of pelvic infection, does decrease operative blood loss, and does not significantly affect blood pressure.

Patellar taping: a radiographic examination of the medial glide technique.

The purpose of this study was to radiographically determine the effectiveness of the McConnell medial glide patellar taping technique. Twenty apparently healthy men, between ages 18 and 35, participated in this study. Subjects underwent a series of three radiographs in a modified Merchant view. First, a bilateral tangential view of the patellofemoral joints was taken to establish a baseline. Next, the same view was obtained with the experimental knees taped using the McConnell medial glide technique. Subjects then underwent a standardized exercise protocol to stress the tape and the accompanying knee structures. This was followed by a third view of the patellofemoral joints. Radiographs were measured using the Merchant congruence angle and analyzed statistically with dependent, mean difference tests. Results from this study indicate that the McConnell medial glide technique was effective in significantly moving the patella medially (P = 0.003), but that the tape was ineffective in maintaining this significance after exercise (P < 0.001). In 3 subjects (15%) of this sample, the tape was ineffective in moving the patella medially in any degree. One interesting finding was that exercise caused a statistically significant (P = 0.016) lateral shift from baseline in the control knees. This may suggest some clinical significance for patellar taping in preventing excessive lateral shift.

Comparative neuroanatomical distribution of the kappa and mu opioid receptors in guinea pig brain sections.

The opiate family of receptors is believed to consist of the mu, delta, kappa and sigma subtypes. Autoradiographic studies have been conducted to define the distribution of the mu and delta receptors. However, due to the lack of a selective ligand definitive studies have not been reported for the kappa receptor. Recently such a ligand was discovered and characterized. Results are presented in which the distribution of kappa receptors in guinea pig brain slices were determined using autoradiographic techniques and its distribution compared to that of a typical mu ligand. The results demonstrate numerous differences between the two opioid systems. The kappa receptors predominate in the prefrontal cortex, the nucleus accumbens, and deep cortex; whereas the mu receptors have a more intense, broader and different distribution.

A double-blind comparison of flurbiprofen with diflunisal in the treatment of acute ankle sprains and strains.

Fifty patients with acute ankle sprains/strains were treated with either 100 mg flurbiprofen or 500 mg diflunisal twice daily in a double-blind fashion for 18 days or until symptoms of the injury resolved. Tolerability of the drugs was evaluated by recording the occurrence of adverse drug reactions and monitoring laboratory parameters. Efficacy measurements were performed at enrollment and at Visit 2-Day 7, Visit 3-Day 14 and Visit 4-Day 21 to determine relief of symptoms and return to normal activities. Patients in both treatment groups exhibited marked improvement by Visit 2-Day 7 with almost complete recovery by Visit 3-Day 14. Flurbiprofen patients had a significantly shorter duration of therapy. Results from three of the six physician assessments were marginally to significantly superior for patients in the flurbiprofen group. The only reported adverse event was mild gastro-intestinal intolerance in a patient receiving diflunisal. Flurbiprofen and diflunisal appear to be effective and well-tolerated medications for the treatment of acute ankle sprains and strains.

Physiological characteristics of Streptococcus dysgalactiae and Streptococcus uberis and the effect of the lactoperoxidase complex on their growth in a chemically-defined medium and milk.

Aerobic or anaerobic degradation of glucose by Streptococcus dysgalactiae and Streptococcus uberis yielded products qualitatively similar to those observed previously for Streptococcus agalactiae. There were, however, quantitative differences. Though acetoin was formed during aerobic growth of Streptococcus uberis, there was none with Streptococcus dysgalactiae. Differences between Streptococcus dysgalactiae and Streptococcus uberis in their aerobic metabolism of glucose was in lower oxygen consumption (.5 mol/mol of glucose), greater conversion of glucose to lactic acid, and lower molar growth yields with Streptococcus uberis. Cell suspensions of Streptococcus uberis had strong peroxidase activity, and no hydrogen peroxide accumulated during the respiration on glucose. With Streptococcus dysgalactiae, there was more oxygen consumed during growth (1.5 mol/mol of glucose used), greater conversion of glucose to acetic and formic acids and carbon dioxide, and a cell yield of about 6 g of dry cells more per mole of glucose than with Streptococcus uberis. This increase in molar growth yield with Streptococcus dysgalactiae over Streptococcus uberis could be nearly all accounted for by differences in the amount of substrate level adenosine triphosphate generated. Cell suspensions oxidizing glucose accumulated hydrogen peroxide and showed no peroxidase activity. Streptococcus dysgalactiae showed the same growth relationships in three milk media as Streptococcus agalactiae, although growth and acid formation values were much lower. Growth inhibition by the lactoperoxidase complex was reversed with cystine. Acid formation by Streptococcus uberis was decreased by the lactoperoxidase complex and increased by the addition of cystine; however, neither appeared to affect the growth of the organism.

[3H]U-69593 a highly selective ligand for the opioid kappa receptor.

The selective kappa agonist U-50488 was recently discovered and characterized. In this study, the receptor binding properties of [3H]U-69593, an analog of U-50488, were characterized. [3H]U-69593 binds with high affinity (3 nM) to membranes prepared from guinea pig, mouse and rat brain. The number of kappa binding sites comprise only 13%, 9% and 4% of the total opioid sites, respectively. The benzmorphans, dynorphin, and compounds structurally related to U-50488 have high affinity for this kappa site.

Demonstration of non-opioid sigma binding with (d)3H-SKF 10047 in guinea pig brain.

A non-opioid binding site to (d)3H-SKF 10047 (N-allyl-normetazocine), the prototypic ligand for the sigma or PCP-like receptor, was demonstrated. The (d) isomer of 3H-SKF 10047 was used to demonstrate a stereospecific low affinity binding site with a Kd of 173nM. It was naloxone insensitive with an IC50 of greater than 10,000nM, which defined it as non-opioid. Traditional mu compounds like morphine and FK 33824 were also inactive, with IC50's of greater than 10,000nM. Kappa compounds such as ethylketocyclazocine and U-50,488H were active as were all of the benzmorphans tested, with butorphanol the least active. The known antipsychotic haloperidol was the most active compound tested, with an IC50 of 11nM. Other antipsychotics which demonstrated activity were chlorpromazine and pimozide. The atypical antipsychotic clozapine was inactive.

3H-SKF10047 receptor binding studies. Attempts to define the opioid sigma receptor.

The results of experiments are described in which attempts have been made to use the multi-site ligand (d,l)3H-SKF10047 to define a binding site that may be the opioid sigma site. This was attempted by using highly selective blocking agents to eliminate binding at the other opioid sites. The remaining bound 3H-SKF10047, approximately 20% of total specific bound, was then characterized using competitive binding studies with different types of opioids. Under these conditions, a binding site was identified which is highly selective for the benzmorphans and certain morphinans known to cause dysphoria. The kappa selective agent (l)U-50488 did not demonstrate high activity for this site and neither did several mu opioids, PCP or the (d) enantiomers of two opioid benzmorphans. The carefully defined site may be the putative opioid sigma receptor.

Cystine antagonism of the antibacterial action of lactoperoxidase-thiocyanate-hydrogen peroxide on Streptococcus agalactiae.

Cystine reduction in Streptococcus agalactiae, resulting in sulfhydryl formation, may account for antagonism of the antibacterial effect of lactoperoxidase-thiocyanate-hydrogen peroxide when cystine is present in excess of the amount needed for maximum growth. Accumulation of cystine by S. agalactiae and its reduction to form sulfhydryl compounds were demonstrated. The reduction of cystine appeared to occur by a couple reaction between glutathione reductase and glutathione-disulfide transhydrogenase activity, both of which were found in the supernatant fraction from cell homogenates. NADPH-specific glutathione reductase activity was found in the pellet and supernatant fractions from cell homogenates. Two sulfhydryls were formed for each mole of NADPH used during cystine reduction. The information presented offers a plausible explanation of how cystine, when present in excess of growth needs, may be reduced to generate sulfhydryl compounds which neutralize the antibacterial effect of lactoperoxidase-thiocyanate-hydrogen peroxide on S. agalactiae.

The evolution and histopathology of adolescent tibia vara.

This clinical, radiographic, and histologic study clarifies the evolution of the distinct clinical and radiographic disorder known as adolescent tibia vara (Blount's disease). Although previous reports have suggested that the disorder occurs in a limb that has been normally aligned until adolescence, we have found that most children with adolescent tibia vara maintain a mild degree of infantile physiologic genu varum. Then, concurrent with the adolescent growth spurt, certain children with predisposing factors, such as obesity, extreme activity, or rapid growth, injure the posteromedial physis as a result of repetitive trauma due to normal use of a limb already in mild varus. The result is growth suppression, further varus, and a classic radiographic presentation. Histologic examination in two cases suggests injury to the growth plate as demonstrated by fissuring and clefts in the physis as well as fibrovascular and cartilaginous repair tissue at the physeal-metaphyseal junction. Transverse trabeculae, resembling growth arrest lines, were noted in the adjacent metaphysis; however, true bony bridging of the growth plate was not seen. Recommended treatment is corrective osteotomy below the growth plate.

Lymphangioma of the forearm and hand.

Cases of cavernous lymphangioma of the forearm and hand were reviewed in five female and four male patients. The tumor was first observed at a median age of 2 weeks, and tissue diagnosis confirmed at a median of 1.75 years. At a median follow-up of 11 years, all patients were symptomatic, describing pain when the affected area was bumped, pain with use, swelling, and extremity weakness. Five patients had experienced a previously undescribed episodic pain syndrome of simultaneous pain, swelling, induration, erythema, and fever. All cases responded favorably to elevation, analgesics, and antibiotics. Nine patients underwent a total of 18 operative procedures, including incisional biopsy, excisional biopsy, and excision of recurrent tumor, with a 33% complication rate. In only one case did surgery eliminate a small superficial tumor of the thumb; all other patients had recurrence of the tumor. Following attempted excision of cavernous lymphangioma of the forearm and hand, tumor recurrence, hypertrophic scars, and persistence of symptoms may be anticipated.

Fine-needle aspiration biopsy of bone.

The technique of fine-needle aspiration biopsy seems to be ideally suited for the diagnosis of lytic bone lesions at practically any location in the skeleton. The technique is simple, carries minimum risks, and can often be performed on an outpatient basis. Advances in cytological techniques have made it possible to reach an accurate diagnosis for most patients within twenty-four hours. The accuracy rate in the present study of seventy patients was 87.5 per cent, but the lesions studied included few primary bone tumors. One limitation of the technique is the difficulty in sampling a lesion that is covered by compact bone.

Effect of hip position on blood flow to the femur in puppies.

Utilizing radioactive microspheres, blood flow to the femoral head of immature dogs was measured. Blood flow was measured with the leg in the control position, maximal abduction, submaximal abduction, and the human position of hip immobilization. Maximal abduction (to 90 degrees) significantly decreased flow to the capital femoral epiphysis. Submaximal abduction and the human position did not reduce blood flow. Measurement of flow in the control position immediately after forced abduction demonstrated marked reactive hyperemia. These data indicate that ischemia occurs during 90 degrees forced abduction of the hip. This finding supports the use of lesser degrees of abduction for hip immobilization in the treatment of congenital dislocation of the hip. The vascular anatomy of the head of the femur in puppies and children suggests that these data can be extrapolated to man.

Resection and Zickel device fixation for metastatic tumor.

In 2 cases of impending pathologic fracture of the proximal femur, the treatment was resection of the metastatic site. The diagnoses were metastatic pheochromocytoma and metastatic renal cell carcinoma. Successful stabilization in th proximal femur was achieved with the Zickel device, wire mesh, and methylmethacrylate.

A histochemical study of slipped capital femoral epiphysis.

UNLABELLED: Core biopsies of the proximal femoral growth plate from three patients with slipped capital femoral epiphysis were compared with three normal growth plates from patients of similar ages. The growth plates of patients with slipped capital femoral epiphysis had a normal resting zone, a loose and fibrillated proliferative zone, and a very disarranged and thickened hypertrophic zone. The proliferative zone stained strongly with alcian blue, suggesting the presence of abundant proteoglycans in the cartilage matrix. The thickened hypertrophic zone was strongly positive to periodic acid-Schiff stain, indicating the presence of abundant structural glycoproteins. Enchondral ossification was scanty and irregular, and there were large clusters of cartilage in the metaphysis. Slippage occurred through the thickened proliferative and hypertrophic zones. CLINICAL RELEVANCE: The proximal femoral growth plate in slipped capital femoral epiphysis is histochemically abnormal and histologically disarranged. These features contribute to abnormal widening of the growth plate and to further slippage.