Validated age-specific reference values for CSF total protein levels in children.

OBJECTIVE: To define age-specific reference values for cerebrospinal fluid (CSF) total protein levels for children and validate these values in children with Guillain-Barré syndrome (GBS), acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS). METHODS: Reference values for CSF total protein levels were determined in an extensive cohort of diagnostic samples from children (<18 year) evaluated at Erasmus Medical Center/Sophia Children's Hospital. These reference values were confirmed in children diagnosed with disorders unrelated to raised CSF total protein level and validated in children with GBS, ADEM and MS. RESULTS: The test results of 6145 diagnostic CSF samples from 3623 children were used to define reference values. The reference values based on the upper limit of the 95% CI (i.e. upper limit of normal) were for 6 months-2 years 0.25 g/L, 2-6 years 0.25 g/L, 6-12 years 0.28 g/L, 12-18 years 0.34 g/L. These reference values were confirmed in a subgroup of 378 children diagnosed with disorders that are not typically associated with increased CSF total protein. In addition, the CSF total protein levels in these children in the first 6 months after birth were highly variable (median 0.47 g/L, IQR 0.26-0.65). According to these new reference values, CSF total protein level was elevated in 85% of children with GBS, 66% with ADEM and 23% with MS. CONCLUSION: More accurate age-specific reference values for CSF total protein levels in children were determined. These new reference values are more sensitive than currently used values for diagnosing GBS and ADEM in children.

Relatively low endogenous fatty acid mobilization and uptake helps preserve insulin sensitivity in obese women.

BACKGROUND: Although obesity is commonly linked with metabolic disease risk, some obese adults do not develop metabolic abnormalities, such as insulin resistance. OBJECTIVES: The primary aim of this study was to determine whether alterations in fatty acid mobilization and uptake underlie differences in insulin sensitivity (Si) among a seemingly homogeneous cohort of obese women. METHODS: Insulin sensitivity (frequently sampled intravenous glucose tolerance test), basal fatty acid rate of disappearance from plasma (Rd), resting whole-body fat oxidation, intramyocellular triacylglycerol (IMTG) concentration and markers of skeletal muscle inflammation were measured in 21 obese women. Participants were divided into tertiles based on their S(i). The subset of participants with the lowest S(i) (LOW-S(i); S(i) ⩽ 2.1 (mU/l)(-1) min(-1); n = 7) was compared with the subset of participants with the highest S(i), who exhibited relatively normal insulin sensitivity (NORM-S(i); S(i) ⩾ 3.4 (mU/l)(-1) min(-1); n = 8). RESULTS: Despite nearly identical physical characteristics in LOW-S(i) vs NORM-S(i) (body mass index: 34 ± 2 vs 34 ± 1 kg m(-2); %body fat: 48 ± 1 vs 47 ± 1%; waist circumference: 104 ± 2 vs 104 ± 2 cm; VO2 max: 2.2 ± 0.2 vs 2.3 ± 0.1 l min(-1)), fatty acid Rd was nearly 30% lower in NORM (P=0.02). Importantly, the greater rate of fatty acid uptake in LOW-S(i) vs NORM-S(i) did not translate to higher rate of fat oxidation (3.5 ± 0.2 vs 3.7 ± 0.2 µmol kg(-1) min(-1)) or to a measureable difference in IMTG content (68.3 ± 12.7 vs 63.7 ± 6.7 µmol g(-1) dry weight). In conjunction with the lower fatty acid Rd in NORM-S(i) vs LOW-S(i), activation of inflammatory pathways known to impair insulin action in skeletal muscle was also lower (lower phosphorylated c-jun N-terminal kinase (JNK) and higher inhibitor of κB (IκB-α) abundance). In contrast, LOW-S(i) and NORM-S(i) exhibited no differences in plasma markers of inflammation (TNFα, IL-6 (interleukin-6), MCP-1). CONCLUSION: These findings suggest that obese women who maintain a relatively low rate of endogenous fatty acid uptake may be somewhat 'protected' against the development of insulin resistance potentially by less activation of inflammatory pathways within skeletal muscle.

Third degree atrioventricular block and acquired myasthenia gravis in four dogs.

Third degree atrioventricular block was diagnosed in 4 dogs with acquired myasthenia gravis (serum acetylcholine receptor antibody titer > 0.6 nmol/L). All 4 dogs had megaesophagus. Two dogs also had mediastinal thymomas, which were resected. One dog with thymoma received a permanent pacemaker at the same time that it underwent thymectomy; the other did not develop third degree atrioventricular block until 3 months after thymectomy. Both dogs with thymoma died of severe aspiration pneumonitis within 3 months after surgery. The third dog received a permanent pacemaker and was treated with pyridostigmine bromide, but also died of aspiration pneumonitis 1 month after the pacemaker was implanted. The fourth dog was treated with prednisolone and pyridostigmine bromide and improved, but did not become clinically normal. Because third degree atrioventricular block as well as myasthenia gravis can cause signs of weakness, acquired myasthenia gravis should be considered in dogs with idiopathic cardiac conduction disturbances. Likewise, an ECG should be evaluated in dogs with acquired myasthenia gravis.

Hematologic emergencies.

The most common life-threatening hematologic emergencies include hemorrhage and severe anemia. Successful treatment of these conditions depends on the emergency veterinarian having a thorough understanding of the possible etiologies of these conditions, and a systematic approach to diagnosis and therapy. Use of blood component therapy can be a life-saving technique in these patients. The goal of this article is to familiarize the emergency veterinarian with a systematic approach to the diagnosis and treatment of hematologic emergencies.

Pathogenesis and treatment of canine rhinitis.

Unless a systematic approach is used, evaluation of a patient with rhinitis can be frustrating to the veterinary practitioner. A complete differential list for canine rhinitis should include infectious, inflammatory, neoplastic, and traumatic causes. Other causes of rhinitis include dental disease, parasitic infestation, and ciliary dyskinesia. Diagnostic techniques that should be considered when evaluating a patient with rhinitis include obtaining a complete history, performing a thorough physical and oral examination, evaluating the patient's coagulation abilities, cytology and culture of exudate, nasal radiographs, and rhinoscopy. This article describes the pathogenesis and treatment of the various causes of canine rhinitis.

Pathogenesis and treatment of feline rhinitis.

Diagnosis and treatment of feline rhinitis, like canine rhinitis, can be a frustrating experience for the veterinary practitioner. Having sound knowledge of the possible etiologies involved and using a systematic diagnostic approach makes the workup of these challenging cases much easier. Selection of appropriate therapy based on a definitive diagnosis makes treatment rewarding. This article discusses the pathogenesis and treatment of a variety of causes of feline rhinitis.

Controversial issues in drug treatment during cardiopulmonary resuscitation.

The goal of advanced life support in CPR must be to restore and maintain respiratory and hemodynamic effectiveness, and to correct the underlying dysrhythmia. Optimal basic life-support techniques must be continued to meet these goals. Many drugs have been suggested in the treatment of cardiac arrest, but unfortunately, drug effects are inconsistent and resuscitation rates remain low. Epinephrine, atropine, lidocaine, bretylium, and naloxone remain important drugs for consideration in CPR in most animals with cardiac arrest. The best chance of survival remains in early recognition of animals susceptible to arrest and in treatment of the underlying cause.

Respiratory and cardiopulmonary arrest in dogs and cats: 265 cases (1986-1991).

Outcomes of cardiopulmonary arrest and resuscitation in clinically affected dogs and cats have not been adequately studied. We examined the records from 200 dogs and 65 cats that had received cardiopulmonary resuscitation for respiratory or cardiopulmonary arrest; none of the animals had been anesthetized or intubated at the time of arrest, and all had been hospitalized in a veterinary critical care facility. Cardiopulmonary arrest was found to be more common than respiratory arrest in dogs and cats. Hospital discharge rates for animals with cardiopulmonary arrest ranged from 4.1% for dogs to 9.6% for cats, and were consistent with those reported from studies of human beings with cardiopulmonary arrest. Hospital discharge rates for dogs and cats with respiratory arrest were 28% and 58.3%, respectively.

Ventral rhinotomy in the dog and cat.

The nasal cavities of 14 dogs and three cats were explored surgically using a ventral rhinotomy. The exposure achieved through this approach was considered to be equal to a dorsal rhinotomy. One animal died during the immediate postoperative period from perforation of a gastric ulcer. The other animals recovered well and had no significant complications. The long-term survival of the animals was consistent with previous reports for their diseases. Ventral rhinotomy is no more difficult than dorsal rhinotomy, has less patient morbidity and fewer postoperative complications, and is more cosmetically acceptable.

Abnormal bleeding.

Animals with disorders of hemostasis are often presented as emergency patients and, as such, offer a challenge to the attending clinician. This article reviews the basic physiology of hemostasis and laboratory tests used for diagnosis. Guidelines for the evaluation and treatment of patients with bleeding disorders are provided.

Kinetic study of the slow cyanide binding to Glycera dibranchiata monomer hemoglobin components III and IV.

Compared to other monomeric heme proteins and the heme peroxidases, the Glycera dibranchiata monomer hemoglobin components III and IV exhibit very slow cyanide binding kinetics. This is agreement with the previously reported behavior of component II. Similar to component II, components III and IV have been studied under pseudo-first-order conditions at pH 6.0, 7.0, 8.0, and 9.0 by using a 100-250-fold excess of potassium cyanide at each pH. At 20 degrees C with micromolar protein concentrations, kobs for component III varies between 7.08 x 10(-5) s-1 at pH 6.0 and 100-fold cyanide excess and 1.06 x 10(-2) s-1 at pH 9.0 and 250-fold cyanide excess. For component IV, the values are 2.03 x 10(-4) s-1 for 100-fold cyanide excess at pH 6.0 and 4.13 x 10(-2) s-1 for 250-fold cyanide excess at pH 9.0. In comparison to other heme proteins, our analysis shows that the bimolecular rate constant (klapp) is small. For example, at pH 7.0, it is 3.02 x 10(-1) M-1 s-1 for component III and 1.82 M-1 s-1 for component IV, compared to 400 M-1 s-1 for sperm whale metmyoglobin, 692 M-1 s-1 for soybean metleghemoglobin a, 111 M-1 s-1 for guinea pig methemoglobin, and 1.1 x 10(5) M-1 s-1 for cytochrome c peroxidase. Our results also show that the dissociation rates (k-lapp) are extremely slow and no larger than 10(-6) s-1.(ABSTRACT TRUNCATED AT 250 WORDS)