Renal artery aneurysm in hand-assisted laparoscopic donor nephrectomy: case report.

We report a living donor who underwent laparoscopic nephrectomy using a hand-assisted device (HALD). At preoperative arteriography the donor showed a renal artery aneurysm. The patient was a 37-year-old female, 166 cm height, white, weighing 87 kg, HLA identical to the recipient. HALD was indicated due to the better visualization of renal pedicle and greater security in an obese patient. Renal artery aneurysm is a rare condition, with many possible complications. The method proved to be adequate and safe for donor nephrectomy, despite a renal artery aneurysm.

Usefulness of the Framingham risk score and body mass index to predict early coronary artery calcium in young adults (Muscatine Study).

The value of a coronary artery disease prediction algorithm, the Framingham risk score (score), for detecting coronary artery calcium (CAC) was examined in 385 men and 472 women, aged 29 to 43 years. Scores were compared in subjects with and without CAC and were also used to predict presence of CAC. Receiver-operating characteristic curves were computed to compare different prediction models. The score model was compared with age only, natural logarithm of body mass index (lnBMI) only, and score plus lnBMI models. CAC was detected in 30% of men and 16% of women. The mean score was significantly higher in men and women with CAC. For every 2-point increase in the score, the odds of CAC increased by 30% in women and 20% in men. Significant associations between CAC status and risk factors were observed for age in women, and high- density lipoprotein cholesterol and blood pressure in men and women. The area under the receiver-operating characteristic curve for the score was 0.67 and 0.57 for women and men, respectively. When lnBMI was added to the score model, the area increased to 0.76 in women (lnBMI p <0.0001, score p <0.005). For men, the area increased from 0.57 to 0.67, and the score was no longer significant (p >0.60) in the model with lnBMI (p <0.0001). Score predicts CAC in asymptomatic young adults. Inclusion of lnBMI in the score model adds significantly to the prediction of CAC in women and men. The lnBMI model has a greater predictive value than the score in this young population.

Ultrasonographic identification of Dirofilaria immitis in the aorta and liver of a dog.

A 5-year-old sexually intact male mixed-breed dog was evaluated because of suspected vena caval syndrome secondary to heartworm disease. On physical examination, the dog was thin, icteric, and weak and had tachycardia and a cardiac murmur. Serum biochemical and hematologic abnormalities included hyperbilirubinemia, high serum alkaline phosphatase and alanine transferase activities, hypoalbuminemia, leukocytosis, and normocytic normochromic anemia. Dirofilaria immitis microfilariae were seen in a blood smear. Echocardiography was used to confirm the diagnosis of vena caval syndrome. Multiple aberrant adult heartworms were evident ultrasonographically in the abdominal aorta and its branches and within hypoechoic nodules in the left caudal lobe of the liver. The dog's condition deteriorated despite supportive treatment and retrieval of 58 adult heartworms from the right side of the heart and vena cava, and the dog was euthanatized. At necropsy, adult heartworms were found in the aorta and inflammatory hepatic nodules. To our knowledge, ultrasonographic identification of heartworms within the systemic arterial system and liver of a dog has not been described previously.

Estenosis hipertrofica del piloro: analisis de 210 casos / Hypertrophic pyloric stenosis: analysis of 210 casos

Se presenta un analisis retrospectivo de 210 pacientes, ingresados por estenosis hipertrofica del piloro (EHP) y tratados quirurgicamente, entre 1975 y 1994. El estudio revelo un predominio de varones primogonitos, eutroficos, con un peso de nacimiento superior a los 3.000 g.Los sintomas mas importantes fueron los vomitos, que se presentaron en el 98,75 por ciento de los casos. La constipacion tuvo baja incidencia (22,85 por ciento). La oliva piloricase palpo en el 70,47 por ciento. La seriada esofagogastroduodenal confirmo el diagnostico en todos los pacientes. Hubo perforacion accidental de la mucosa en 6 casos (2,8 por ciento). La mortalidad fue del 1,9 por ciento (4 casos)

Estenosis hipertrofica del piloro: analisis de 210 casos / Hypertrophic pyloric stenosis: analysis of 210 casos

Se presenta un analisis retrospectivo de 210 pacientes, ingresados por estenosis hipertrofica del piloro (EHP) y tratados quirurgicamente, entre 1975 y 1994. El estudio revelo un predominio de varones primogonitos, eutroficos, con un peso de nacimiento superior a los 3.000 g.Los sintomas mas importantes fueron los vomitos, que se presentaron en el 98,75 por ciento de los casos. La constipacion tuvo baja incidencia (22,85 por ciento). La oliva piloricase palpo en el 70,47 por ciento. La seriada esofagogastroduodenal confirmo el diagnostico en todos los pacientes. Hubo perforacion accidental de la mucosa en 6 casos (2,8 por ciento). La mortalidad fue del 1,9 por ciento (4 casos)

Coronary risk factors measured in childhood and young adult life are associated with coronary artery calcification in young adults: the Muscatine Study.

OBJECTIVES: This study was designed to estimate the prevalence of coronary artery calcification in young adult men and women and to examine the association between the presence of coronary artery calcification and coronary risk factors measured in childhood and young adult life. BACKGROUND: Electron beam computed tomography is a sensitive, noninvasive method for detecting coronary artery calcification, a marker of the atherosclerotic process. Coronary artery calcification is associated with coronary risk factors in older adults. METHODS: Subjects (197 men, 187 women) had coronary risk factors measured in childhood (mean age 15 years) and twice during young adult life (mean ages 27 and 33 years). Each underwent an electron beam computed tomographic study at their second young adult examination. RESULTS: The prevalence of coronary artery calcification was 31% in men and 10% in women. Increased body size, increased blood pressure and decreased high density lipoprotein (HDL) cholesterol levels were the coronary risk factors that showed the strongest association with coronary artery calcification. Significant odds ratios for coronary artery calcification, using standardized risk factor measurements at a mean age of 33 years in men and women, respectively, were 6.4 and 13.6 for the highest decile of body mass index, 6.4 and 6.4 for the highest decile of systolic blood pressure and 4.3 and 4.7 for the lowest decile of HDL cholesterol. CONCLUSIONS: Coronary artery calcification is more prevalent in men in this young adult population. Coronary risk factors measured in children and young adults are associated with the early development of coronary artery calcification. Increased body mass index measured during childhood and young adult life and increased blood pressure and decreased HDL cholesterol levels measured during young adult life are associated with the presence of coronary artery calcification in young adults.

Mothers remember birthweights of adolescent children: the Muscatine Ponderosity Family Study.

The mothers of 127 adolescents living in Muscatine, Iowa were asked at the time of a clinic examination to recall their child's birthweight in pounds and ounces. For comparison, the hospital-recorded birthweight was obtained for each child. On the average, mothers underreported their child's birthweight by 1.3 oz. Sixty of 127 (47%) mother-reported birthweights were the same as those from hospital delivery records; 12% of the mothers overreported the birthweight by at least 5 oz and 17% underreported by at least that amount. The age of the mother and number of biological children were related to the ability to recall the birthweight exactly. The mean age of the children, and thus the average length of the mother's recall, was 16.1 years. Neither the length of recall, nor the mother's education, her current body size, or the current body size of the child were related to recall ability. However, mothers who overreported their child's birthweight were significantly shorter and lighter and their children tended to be taller and heavier, when compared to the mothers who underreported and their children. When the degree of agreement found in our study between reported and recorded birthweight exists, the effect of using reported rather than recorded birthweights in an epidemiological investigation is sufficiently small to allow inferences to be made regarding the relationship between birthweight and body size at mid-adolescence.

The constant plasma 18-hydroxycorticosterone to aldosterone ratio: an expression of the efficacy of corticosterone methyloxidase type II activity in disorders with variable aldosterone production.

Aldosterone and 18-hydroxycorticosterone (18-OHB) are produced by the adrenocortical zona glomerulosa. Under normal conditions, plasma 18-OHB levels parallel and are influenced by the same trophic factors that regulate aldosterone production. To evaluate corticosterone-methyl-oxidase II activity, the final step of aldosterone biosynthesis, in conditions associated with chronic derangements of the pituitary-adrenal and/or renal-adrenal axis, we measured the plasma 18-OHB to aldosterone ratio, cortisol, PRA or plasma renin concentration, and potassium (K) in 104 such patients and 15 normal subjects. The 18-OHB to aldosterone ratios in the pituitary-adrenal group were not significantly different from normal regardless of elevated or reduced ACTH and/or cortisol levels [patients with Cushing's syndrome, 3.55 +/- 0.68 (+/-SE); ACTH deficiency, 2.03 +/- 0.34; 21-hydroxylase deficiency, 3.09 +/- 0.23; normal subjects, 2.50 +/- 0.15]. The renal-adrenal group also had normal ratios regardless of plasma renin concentration and K levels [patients with aldosterone-producing adenomas, 2.85 +/- 0.15; idiopathic hyperaldosteronism, 2.14 +/- 0.19; salt-losing nephropathy, 3.06 +/- 0.54; Bartter's syndrome, 2.89 +/- 0.20; isolated (hyporeninemic) hypoaldosteronism, 3.20 +/- 0.39]. Only in patients with 17 alpha-hydroxylase deficiency (230.1 +/- 118.6) was the ratio abnormally high. Chronic perturbations of aldosterone production by ACTH, the renin-angiotensin system, and/or K did not alter this last step of aldosterone biosynthesis (corticosterone-methyloxidase II), as defined by their plasma concentrations. Any influence of these trophic factors must be proximal to the site of 18-OHB production.

Cancer incidence in humans: relationship to plasma lipids and relative weight.

Surveillance was done on cancers in subjects in rural Iowa for 6 years after they participated in a cardiovascular risk factor-screening program. Among 5,565 men and women 20-94 years old at screening, 131 persons were identified as having cancers. Each cancer patient was matched to a control without cancer, and differences in antecedent plasma cholesterol and triglyceride levels and relative weight were sought. Mean relative weight at screening was lower among cancer patients of both sexes than among controls. Plasma cholesterol levels were lower among male patients and higher among female patients than among controls, with the differences more prominent for those less than 60 years old at screening. In males, the lower cholesterol levels occurred only in those with neoplasms developing within 24 months of screening. The higher cholesterol levels among female patients with cancers limited to gonadal hormone-related sites were not time-dependent. Triglyceride levels were not significantly different between cancer patients and controls in any analytic group, but triglyceride levels did closely parallel cholesterol alterations. A minimum of 1% of the cohort had diagnosed cancers before the screening program.

In vitro stimulation of 25-hydroxycholecalciferol 1 alpha-hydroxylation by parathyroid hormone in chick kidney slices: evidence for a role for adenosine 3',5'-monophosphate.

We studied the effect of parathyroid hormone (PTH) on the in vitro conversion of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol [1,25-(OH)2D3] by kidney slices from vitamin D-deficient chicks. Bovine PTH (bPTH) stimulated 1,25-(OH)2D3 production at low concentrations, with maximal stimulation (65%) at a concentration of 25 ng/ml bPTH in the absence of theophylline. Higher concentrations of bPTH resulted in less stimulation. The addition of 5 mM theophylline to the incubation buffer decreased basal 1,25-(OH)2D3 production but potentiated the stimulation of 1,25-(OH)2D3 production by PTH. Maximal stimulation (170%) was observed with 2 ng/ml bPTH in the presence of theophylline. Maximal stimulation of cAMP production by the kidney slices required 2- to 3-fold larger concentrations of bPTH. However, cAMP by itself stimulated 1,25-(OH)2D3 production, with maximal stimulation (70%) at 10(-7)-10(-5) M cAMP. We conclude that stimulation by PTH of 1,25-(OH)2D3 production can be potentiated by theophylline and mimicked by cAMP. However, such stimulation occurs at PTH concentrations lower than that required for optimal stimulation of adenylate cyclase activity.

Effect of sulfonylurea therapy and plasma glucose levels on hemoglobin A1c in type II diabetes mellitus.

It is well known that hemoglobin A1c reflects plasma glucose concentrations in patients with diabetes mellitus. To examine hemoglobin A1c and plasma glucose relationships in sulfonylurea-treated patients, 25 patients with well-controlled type II diabetes (fasting plasma glucose 128 +/- 6 mg/dl, hemoglobin A1c 7.6 +/- 0.5 percent) were evaluated in a double-blind study. This study was divided into two phases (periods I and II). During period I each patient was given a diet plus a placebo and was followed every two weeks until the mean of two consecutive plasma glucose determinations was more than 50 mg/dl above the initial plasma glucose concentration obtained while the patient was taking sulfonylurea. At that point each patient was switched in a double-blind fashion to either diet plus a placebo or diet plus tolazamide. Fasting plasma glucose concentrations increased to 178 +/- 9 mg/dl (p less than 0.005) for all patients by week 2 of period I. The increase in hemoglobin A1c concentration was seen to lag behind the increasing fasting plasma glucose concentration by four to six weeks. Fasting plasma glucose and hemoglobin A1c concentrations returned to values indistinguishable from initial values in patients who were given tolazamide and who responded to it. A positive correlation was noted when the hemoglobin A1c concentration was compared with the fasting plasma glucose concentration measured four to six weeks previously.

Use of computed tomography in diagnosing the cause of primary aldosteronism.

We performed computed tomography (CT) in 22 consecutive patients with primary aldosteronism to evaluate the usefulness of this technique in diagnosing and locating aldosterone-producing adenomas. Sixteen patients had severe hypokalemia, hyperaldosteronism, and elevated plasma levels of 18-hydroxycorticosterone suggestive of an adenoma. In 12 of these 16, a unilateral adrenal mass was demonstrated clearly, and in all 11 who had surgery in adenoma was confirmed. In the other four patients in this group, one adrenal gland was normal and the other was either not seen adequately or had minor abnormalities that could not be definitely classified; an adenoma was found in the poorly visualized gland in each of the two patients who had surgery. The remaining six patients, who had milder biochemical abnormalities suggestive of idiopathic hyperaldosteronism, had bilateral adrenal enlargement or normal-appearing glands on scan and were not surgically explored. We conclude that CT scans, together with appropriate biochemical measurements, are useful in diagnosing and locating aldosterone-producing adenomas.

Prolactin but not growth hormone stimulates 1,25-dihydroxyvitamin D3 production by chick renal preparations in vitro.

We studied the effect of PRL from two species (bovine and turkey) and GH from two species (bovine and turkey) on 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] production by two whole cell preparations from vitamin D-deficient chick kidneys (slices and tubules). We observed that 8 ng/ml turkey PRL stimulated 1,25(OH)2D3 production by renal tubules and slices. Ovine PRL had a similar effect on 1,25(OH)2D3 production but at higher concentrations. In contrast, neither bovine GH nor turkey GH stimulated 1,25(OH)2D3 production appreciably at doses up to 1000 ng/ml. The effect of PRL on 1,25(OH)2D3 production by renal tubules required a 3-h preincubation, although its effect on 1,25(OH)2D3 production by renal slices was immediate. We conclude that PRL, but not GH, directly stimulates 1,25(OH)2D3 production by the chick kidney.

Adrenocorticotropin inhibition of mineralocorticoid hormone production.

1. Adrenocorticotropin (ACTH)-induced steroidogenesis, obtained by continuous administration of ACTH for 3 days, produces in man (a) sustained elevations of plasma deoxycorticosterone and cortisol concentrations, (b) transient elevations of plasma aldosterone and 18-hydroxycorticosterone concentrations that return to near-control values, and (c) brisk initial increases in plasma 18-hydroxydeoxycorticosterone and corticosterone concentrations that fall to 20-68% of peak values 30 h thereafter. 2. Dexamethasone (8 mg/day, orally) treatment for 2 days in man permits a greater postural increase in plasma aldosterone and 18-hydroxycortisone concentrations. A dampening effect of ACTH is suggested. 3. An ACTH-initiated inhibition of 11 beta- and 18-hydroxylation is proposed to be operative in regulation of mineralocorticoid hormones.