Pseudostenosis of axillary vein due to adduction of the upper limb.

Axillary vein stenosis is a well-documented complication in hemodialysis (HD) patients, but in adipose or athletic subjects, pseudostenosis of the axillary vein can be detected. We report a case of pseudostenosis in a fit dialysis patient who underwent phlebography of the right upper limb, performed to create a new vascular access (VA). The investigation demonstrated that the axillary vein appeared sharpened with a reduced lumen. Based on this exam, angioplasty of the right axillary vein was planned. The new phlebographic study, performed abducting the arm, demonstrated that the previously marked stenosis of the axillary vein disappeared. Our case illustrates how the reduction of the axillary vein lumen was secondary to ""muscular print"" and was present only if the arm was adducted. In uremic patients, the squeezing of the vascular nervous bundle of the upper limb is possible in fit patients at the time of phlebography, an examination that should be performed with the arm both in adduction and abduction.

[MEN type 1 and chronic renal failure: a rarely reported association]. / MEN tipo 1 ed insufficienza renale: una associazione poco conosciuta.

BACKGROUND: Multiple endocrine neoplasia type 1 (MEN 1), or Wermer's syndrome, is a rare autosomal dominant genetic syndrome characterized by tumors or hyperplasia involving the pituitary, parathyroid, and pancreatic islet cells. Association between MEN 1 and nephrocalcinosis is well known, though data published in medical literature regarding Wermer's syndrome and chronic renal failure relation are still rare. CASE: A 70-year-old Caucasian female patient had a history of primitive hyperparathyroidism, prolactinoma, glucagonoma, adrenal adenoma and pulmonary neuroendocrine neoplasia. She presented at our clinic first when she was 62 years old because of hypertension, nephrolithiasis (calcium oxalate) and diabetes mellitus treated with oral agents. During the eight-year follow-up she developed chronic renal failure (serum creatinine 1.8 mg/dL, glomerular clearance 35 mL/min) and partial thrombosis of abdominal aortic wall. CONCLUSIONS: Although the association between renal failure and MEN 1 is rarely reported, patients affected by Wermer's syndrome have several risk factors of decreasing renal function such as hypertension, nephrolithiasis and diabetes mellitus. Moreover, hyperparathyroidism in MEN 1 is clinically similar to the kidney failure condition; indeed, diffuse hyper-plasia of more than one gland is common. Vitamin D should not be administered to these patients. Nephrologists should be involved in MEN 1 follow-up, with the aim to prevent kidney failure development by correcting risk factors.

Impact of new diagnostic criteria on the prevalence and incidence of pelvic inflammatory disease.

STUDY OBJECTIVE: The Centers for Disease Control and Prevention (CDC) recently changed the recommended criteria for the clinical diagnosis of pelvic inflammatory disease (PID). The purpose of this study was to assess the impact of this change on the frequency with which we made a diagnosis of PID. DESIGN: prospective cohort study. SETTING: juvenile detention center. PARTICIPANTS: adolescent females. INTERVENTIONS: We used the new diagnostic criteria to determine the prevalence and incidence of PID. We then compared these values to those in a previous study of a similar cohort of youth who were evaluated with the CDC's old, more stringent clinical criteria. MAIN OUTCOME MEASURES: Prevalence and incidence of PID. INCIDENCE MEASURES: Incidence density and cumulative incidence, using the Kaplan-Meier method. Results between studies were compared using prevalence and incidence ratios. RESULTS: In sexually active adolescents (N=315), the prevalence of PID (95% confidence interval) at admission was 8.6% (5.7-12.2%). During the first 31 days of incarceration, the cumulative incidence was 7.9% (5.0-12.3%) and the incidence density was 11.1 cases/100 person-months (6.5-16.4). Comparison of these results with those of our previous study that used old diagnostic criteria yielded a prevalence ratio of 2.0 (1.0-4.2), a risk ratio (comparing cumulative incidence) of 3.6, and a rate ratio (comparing incidence density) of 3.4 (1.2-11.2). All differences were statistically significant (P<0.05). CONCLUSION: The new diagnostic criteria for PID doubled the prevalence and more than tripled the incidence of this disease in this high risk population of incarcerated adolescents.

Ultrasonic vocalizations are elicited from rat pups in the home cage by pentylenetetrazol and U50,488, but not naltrexone.

Although isolated rat pups emit ultrasonic vocalizations (USVs), those kept warm and undisturbed in the home cage with their littermates seldom do. Drugs were administered to 10-day-old pups in the home cage to determine whether pharmacological agents can elicit USV in this familiar environment. Ten-day-old Wistar rats were injected with U50,488, a highly selective kappa opioid agonist; pentylenetetrazol (PTZ), an anxiogenic drug that binds at the GABA-benzodiazepine receptor complex; or naltrexone (NLX), an opiate receptor blocker, and then were returned to their littermates in the home cage. U50,488 increased USV and activity levels, lowered body temperature, and disrupted contact with littermates. PTZ raised activity levels but had a smaller effect on vocalization rates and did not alter temperature or contact with littermates. Behavioral measures and body temperature were unchanged by NLX.