Noninvasive cardiac output monitor to quantify hydration status in ischemic stroke patients: A feasibility study.

BACKGROUND: Individuals who are dehydrated, volume contracted or both at the time of hospitalization for acute ischemic stroke have worse clinical outcomes than do individuals with optimal volume status. Currently, there is no gold standard method for measuring hydration status, except indirect markers of a volume contracted state (VCS) including elevated blood urea nitrogen (BUN)/creatinine ratio. We sought to test the feasibility and acceptability of a non-invasive cardiac output monitor (NICOM) for the measurement of hydration status in a group of hospitalized ischemic stroke patients, and explore the relationship with a common indirect laboratory-based measure of VCS. METHODS: We performed a prospective observational feasibility study of hospitalized acute ischemic stroke patients. We collected hemodynamic parameters using the NICOM device before and after fluid auto-bolus via passive leg raise and BUN/creatinine ratio. Successful acquisition of relevant hemodynamic data was the primary objective of this study. We explored agreement between the NICOM results and BUN/creatinine ratio using Cohen's kappa statistic. RESULTS: Thirty patients hospitalized with acute ischemic stroke were enrolled. We found that 29/30 patients tolerated assessment with NICOM. Hemodynamic data were collected in all 30 patients. Data capture took an average of 10 min(SD ± 112 s). Agreement between NICOM and BUN/creatinine ratio was 70%; (expected agreement 51%; kappa 0.38). Agreement was stronger in the cohort without history of diabetes (81% agreement, kappa 0.61). CONCLUSIONS: NICOM assessment was feasible in hospitalized stroke patients. The identification of an objective, real-time measure of hydration status would be clinically useful, and could allow precise, goal-directed care.

HIDRADENITIS SUPPURATIVA IN POSTMENOPAUSE.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, debilitating disease with a profound impact on the quality of life of patients. OBJECTIVES: To describe a rare case of HS with postmenopausal onset, to review the literature data regarding late onset HS and to discuss the current knowledge on the role of endocrine abnormalities in the development of HS. CASE REPORT: We report the case of a 68-year-old patient in whom HS occurred 10 years after menopause. She was referred to our clinic for the presence of an open fistula on the left groin, fibrotic scars and visible alteration of the vulvar anatomy due to numerous surgical interventions. The patient shared features of the metabolic syndrome (obesity, arterial hypertension, dyslipidemia, aortic atherosclerosis), but showed no signs of virilism and no hormonal abnormality. HS was controlled using antiseptics, topical retinoids and antibiotics. CONCLUSIONS: This case is of particular interest given the late onset of HS, long time after menopause. The development of HS requires a complex interaction between genetic predisposing factors, endocrine dysregulation, metabolic alterations, bacterial overgrowth and an aberrant inflammatory response. Evidence points to an important role of sex-hormones in the emergence and progression of the disease, but the underlying mechanisms are still unclear. A better understanding of HS pathogenesis is needed to elucidate the precise way in which endocrine factors influence the disease onset and course. This would guide the way to novel therapies and a better control of this challenging disease.

Chronic diseases surveillance of St. Regis Mohawk Health Service patients.

A study of the distribution of some chronic diseases among the Akwesasne Mohawks was performed using computerized medical records of the St. Regis Mohawk Health Services Clinic. Prevalence proportions, annual incidence rates, and five-year incidence rates were computed for the period January 1, 1992 to January 1, 1997 for asthma, diabetes mellitus type II, hypothyroidism, and osteoarthritis. Hypothyroidism and diabetes showed higher age-specific prevalence than in the general U.S. population. Osteoarthritis was extremely frequent among people 60 years of age and older, and it may also be elevated in prevalence in relation to the U.S. general population. The incidence and prevalence trends of diabetes type II and osteoarthritis were stationary, but those for asthma and hypothyroidism showed increases over the study period. Morbidity from asthma and acquired hypothyroidism should be monitored in the future and investigated through analytic epidemiologic methods for a possible association with lifestyle and environmental factors.

The assessment of risk to acquired hypothyroidism from exposure to PCBs: a study among Akwesasne Mohawk women.

PCBs are a family of 209 chemical compounds, each of which consists of two benzene rings and 1 to 10 chlorine atoms. Their long-term stability and dispersion into the environment and the food chain have caused concern about their impact on humans and the environment. Native American communities are believed to be at particularly high risk of such exposure since they typically are more dependent than other populations on local fish and game as a food source. We have evidence for a significant excess in incidence and prevalence of hypothyroidism among Mohawks, particularly older women, as compared to other populations. The goal of the current project is to compare serum PCB concentrations to indicators of thyroid function in controls and patients with demonstrated thyroid dysfunction. Studies on experimental animals (rats) have shown significant depression of circulating levels of T4 and moderate reductions in levels of T3 after exposure to PCBs. We are conducting a retrospective observational case-control study. The participants are Mohawk women 30 years of age and older. Controls are participants in an ongoing environmental epidemiology study, whose thyroid hormone tests show a normal function. Our study aims to investigate the association between long-term exposure to PCBs and acquired hypothyroidism, to identify the critical exposure routes and to develop and apply toxic equivalents for thyroid disease for the various PCB congeners. PCB exposure is assessed by ultra-trace, congener-specific determination in blood specimen using GC/ECD. The study is currently ongoing. We have analyzed 46 samples of cases and 75 samples of controls.