A case of metastasizing pleomorphic adenoma.

The pleomorphic adenoma is the most common benign salivary neoplasm. A case is presented in which a palatal pleomorphic adenoma seeded a metastasis in the medullary cavity of the anterior maxilla, apparently by hematogenous spread after surgical manipulation.

Urinary catheter blockage depends on urine pH, calcium and rate of flow.

Urinary catheters tend to block when biofilm from urease-producing organisms build up on the catheter surface. This is a locally-occurring process that influences and influenced by the composition of the urine. In this work we relate urine pH and calcium to catheter blockage and suggest how to reduce the rate of encrustation. Sixty patients with indwelling urinary catheters were studied, 26 of them being troubled by frequent blockage of their catheters, 34 of them not. A series of small urine samples were collected during a 24 h period. Urinary pH and calcium concentration were combined into discriminant functions designed to separate Blockers from Non-blockers and achieved a 95% correct classification. The results indicate that a high and uniform rate of fluid intake is mandatory for the patient with a tendency for catheter blockage. Excessive total fluid intake may be avoided by attention to uniformity. Other avoidable risk factors include: excess dietary calcium from certain protein supplements and antacids; excess dietary magnesium from certain beverages and antacids; alkali from effervescent tablets; excess dietary citrate from some fruit juices and cordials; intermittent dehydration from alcohol ingestion. Less tractable risk factors include infection of the urinary tract with urease-positive organisms, hypercalciuria of immobilisation, hyperhydrosis and postural oliguria. The processes involved in catheter encrustation and blockage provide a model for the formation of calculi in spinal cord injured patients. Therefore the above considerations may also be relevant to the management of stone disease in paraplegic and tetraplegic patients.

The reduced urinary output after spinal cord injury: a review.

Oliguria in patients following spinal cord injury was first mentioned in 1649, but has since been referred to only occasionally. The work detailed here was completed 30 years ago but is reported because of the lack of any comparable study and because suitable patients are not now readily available. A total of 27 water load tests were carried out on 20 patients. The test included measurement of serum osmolality to confirm absorption of ingested water. Impaired response to the water load was obtained in 17 tests: 12/13 between 1 and 5 days after onset of the cord lesion and 5/14 more than 2 weeks after injury. The possibilities that oliguria was due to dehydration, failure to absorb ingested water, hypotension or renal failure are discounted. In the first few days after injury, oliguria may be due to release of antidiuretic hormone as part of the metabolic response to trauma. The impaired response seen later is discussed in relation to possible neural and hormonal mechanisms. There is a need for further study of factors influencing water excretion in tetraplegic and paraplegic patients.

The blocking urinary catheter: the role of variation in urine flow.

OBJECTIVES: To relate blockage of the urinary catheter to urine chemistry. PATIENTS AND METHODS: Of 44 patients (age range 19-72 years) with an indwelling urinary catheter, 21 were troubled by frequent blockage and 23 experienced no blockage. Variation in urinary pH and calcium concentration were determined during a 24 h period and related to the occurrence of blockage using discriminant analysis. RESULTS: The maximum pH and calcium concentrations observed, or the maximum discriminant factors calculated, correctly discriminated 91% of patients (95% CI, 78-97%). CONCLUSION: Attention to volume and variability of fluid intake by the patient should have a major impact on the incidence of blockage of the indwelling urinary catheter.

Creatinine, calcium, citrate and acid-base in spinal cord injured patients.

The aim of this work was to recognise factors responsible for reduced citrate excretion, previously reported in patients with spinal cord lesions and possibly related to the occurrence of urinary tract stone or catheter blockage. Inter alia, a reference range for creatinine in plasma (34-88 mumol/l) was also obtained. Two groups of subjects were studied. The first group consisted of 64 male inpatients with spinal cord lesions and 20 male control subjects. The second group were 342 spinal patients who attended an outpatient clinic and 31 control subjects. Plasma calcium was within the normal range but higher in patients within 1 year of onset of the cord lesion than it was later or than was found in control subjects. Plasma pH and bicarbonate were within the normal range but higher in the patients than in the control subjects. When patients with urea-splitting infection were omitted the patients had a higher urinary pH and a lower urinary ammonium than the controls. Urinary and plasma citrate were lower in the patients than in the controls. Urinary citrate was related to urinary potassium and creatinine clearance. Fractional renal tubular reabsorption of citrate did not differ between patients with normal renal function and control subjects. Patients with normal glomerular filtration had lower filtered load of citrate than the controls. The coincidence of relative alkalosis and reduced citrate excretion may be relevant to the understanding of catheter blockage and urinary stone formation in spinal cord injured patients.

The relationship of heterotopic ossification to passive movements in paraplegic patients.

Heterotopic ossification (HO) occurs in 4-49% of patients with spinal cord injury, but the cause of the complication has not been established. The aim of this study was to investigate clinical factors related to the occurrence of HO. The incidence of HO was determined in 91 consecutive patients with traumatic lesions of the spinal cord who had been admitted to the National Spinal Injuries Centre for management and rehabilitation. Clinical data were analysed. Clinically apparent HO occurred only in 10 of 56 patients in whom the start of passive movements to their paralysed limbs was delayed until 7 days or more from time of injury. The findings of this study are consistent with the view that HO occurs as a result of trauma induced by passive movements carried out on joints where contractures have started to develop.

Haemoglobin and albumin as predictors of length of stay of spinal injured patients in a rehabilitation centre.

The aim of this work was to identify factors related to the length of stay of patients admitted to this centre for rehabilitation. The study involved 200 patients admitted within one year of onset of a spinal cord lesion. Clinical and laboratory data were recorded. Length of stay was related to the level of the spinal cord lesion and whether it was complete or incomplete. The length of stay was increased in patients in whom anaemia or hypoalbuminaemia occurred; the cause of these conditions was not always evident. We conclude that attention directed towards recognising and treating the cause of anaemia or hypoalbuminaemia may be expected to shorten the time required for rehabilitation in this centre.

Blockage of indwelling urinary catheters: the roles of urinary composition, the catheter, medication and diet.

The aim of this work was to study factors related to the blockage of indwelling urinary catheters. There were 40 patients with indwelling catheters, 20 of whom had catheters that blocked frequently. The other 20 were trouble free at the time of our study. The type and gauge of catheter and frequency of events were recorded. Urine samples for biochemical analysis comprised 24-hour collections, morning specimens on up to 10 different days and 5-8 samples at different times during the same day. Chemical analysis of debris removed from blocked catheters showed it to consist of mixed phosphates of calcium and magnesium, thus being similar to urinary stones that may be seen in spinal cord injury patients. Patients with frequent catheter blockage had significantly elevated urinary pH and ammonium and calcium concentrations. Discriminant analysis gave 78-94% separation of catheter blocking patients from nonblockers depending on the type of sample. We conclude that bacterial urease activity and urinary calcium concentration are the most important factors in catheter blockage. Elevation of urinary pH following ingestion of effervescent preparations, drug- or diet-induced increases in urinary calcium or magnesium excretion and inadequate or erratic fluid intake may be avoidable contributing factors.

Associations between mood and specific health composites during U.S. Navy Persian Gulf operations.

Previously conducted field studies using shipboard U.S. Navy personnel during at-sea operations in the Persian Gulf have shown that crew members experience mood changes and degradations in general physical health. The objectives of this study were to: (a) examine the relationship between mood and health complaints among personnel deployed in the Persian Gulf; and (b) extend previous research using specific health composites rather than a general measure of health. Mood was assessed for 104 shipboard volunteers using the Profile of Mood States Tension/Anxiety and Fatigue subscales. Health symptoms were measures using the Environmental Symptoms Questionnaire. Results of multiple regression analyses showed that each of 11 distinct health composites was significantly associated with one or both mood variables. Further, the two mood factors were differentially associated with 9 of the 11 health composites. This study underscores the usefulness of employing multiple specific health measures rather than global measures.

Citrate excretion in spinal cord patients.

Low urinary citrate is a risk factor in calcium renal stone disease. The aim of this work was to identify the factors responsible for the low excretion of citrate frequently observed in patients with spinal cord lesions. Thirty male patients with spinal cord lesions were studied by blood and urine biochemistry. The most important single factor related to urinary citrate was urinary potassium. The presence or absence of urinary stone disease and variations in urinary volume also contributed significantly to variations in citrate excretion. Determination of plasma and urinary citrate, urinary sodium and bacteriological culture of urine permitted complete discrimination of the 7 stone formers from the other patients.

Ten-year profile of infectious and parasitic disease hospitalizations in the U.S. Navy.

Age-adjusted rates of total first hospital admissions of U.S. Navy enlisted personnel with diagnoses of infectious and parasitic diseases declined from a high of 112.9 per 10,000 person-years in 1977 to a low of 50.3 per 10,000 person-years in 1982. Ten specific diagnoses accounted for 78% of these hospitalizations. Eight diagnoses exhibited significant increases in rates over the study period. Improved medical care and prophylaxis, greater emphasis on outpatient care, changing social characteristics of Navy personnel, and changes in deployment theaters may account for the observed trends in hospitalization.

IgE-binding proteins from pine (Pinus radiata D. Don) pollen: evidence for cross-reactivity with ryegrass (Lolium perenne).

A complex mixture of pine (Pinus radiata D. Don) pollen proteins are rapidly released into aqueous solutions. IgE-binding proteins have been identified in these extracts using combined SDS-PAGE immunoblotting techniques. These IgE-binding proteins were detected using atopic patient and commercial pooled human sera known to be high in ryegrass-specific IgE. Enzyme-immunoassay inhibition studies revealed that leached P. radiata pollen proteins could partially inhibit serum IgE binding to ryegrass RAST discs thus providing preliminary evidence for allergen cross-reactivity between these two unrelated species.

Viral hepatitis in the US Navy, 1975-1984.

The epidemiology of viral hepatitis in US Navy enlisted personnel was reviewed for the years 1975-1984. Hospital discharge summaries of all active duty enlisted personnel admitted to a US Navy treatment facility were used for the study. From 1975 to 1984, total first hospitalizations for viral hepatitis declined from 128 per 100,000 personnel (95% confidence interval (Cl) 118-139) to 56 per 100,000 personnel (95% Cl 50-63). The highest incidence of acute viral hepatitis (115 per 100,000 personnel) was found in the youngest age groups aged 24 years and less. Risk factors for acute hepatitis included a previous hospitalization with either drug abuse (relative risk = 363) or a sexually transmitted disease (relative risk = 25) listed among the discharge diagnoses. Having a medical job classification was also associated with an increased risk of acute hepatitis. The steep decline in the incidence of viral hepatitis during this 10-year period may have been due to decreasing drug abuse in the US Navy. Immunization of high-risk groups in the US Navy with hepatitis B vaccine could be an effective policy for the prevention of acute viral hepatitis.

Health profile of U.S. Navy pilots of electronically modified aircraft.

This study compared hospitalization rates of pilots who primarily flew electronically modified aircraft (n = 1,063) with an age-matched group of pilots who flew other types of aircraft (n = 2,126). Of the two groups, control pilots at ages 21-26 had a significantly higher mortality rate for aviation-related injuries and a higher hospitalization rate for the diagnostic category of accidents, poisonings, and violence. Their hospitalization rates also were significantly higher than pilots of electronically modified aircraft for mental disorders at ages 27-32 and supplementary classifications at ages 39-44. Significant age-specific increases in rates were observed for cardiovascular disease and alcoholism in the control group whereas no significant increases were noted for pilots of electronic models. Pilots in the latter group had low rates for conditions postulated as related to radiation exposure. Such results indicated that pilots of electronically modified aircraft were not at increased risk for illness or injury because of the aircraft models they primarily flew.

Health risks among submarine personnel in the U.S. Navy, 1974-1979.

This study evaluated health risks associated with U.S. Navy submarine duty by comparing hospitalization rates of submariners with surface ship personnel. The groups were compared using age-adjusted hospitalization rates for 16 major diagnostic categories and several specific diagnoses postulated to be submarine associated. Submarine personnel did not have significantly higher hospitalization rates for any diagnostic categories nor for any of the submarine-associated illnesses. Submariner relative risk of hospital admissions was greater for a few selected diagnoses but statistical significance was not attained. Submarine personnel had lower hospitalization rates for nearly all of the diagnostic categories examined. Reasons for these lower rates may be stringent screening of submariners, higher levels of education among submariners, difficulty of evacuation from a submarine, and the healthy-worker effect. The health status of U.S. Navy personnel does not seem to be adversely affected by submarine duty.

Biochemical studies in paraplegic renal stone patients. 2. Urinary excretion of citrate, inorganic pyrophosphate, silicate and urate.

The urinary excretions of citrate, inorganic orthophosphate and pyrophosphate, silicate and urate were measured in 17 paraplegic patients with renal calculous disease associated with urinary infection, in 16 paraplegics with no history of urinary calculus and in 14 healthy control subjects. The paraplegics excreted less citrate, orthophosphate and pyrophosphate than the control subjects. The stone-formers excreted more urate than the paraplegics without stone disease, but less than the control subjects. There were significant positive correlations between urinary orthophosphate and pyrophosphate and between urinary silicate and 24-h urine volume. The possible roles of increased urate and diminished excretion of citrate and inorganic pyrophosphate in the aetiology of renal calculosis in paraplegic patients deserve further investigation.

Biochemical studies in paraplegic renal stone patients. 1. Plasma biochemistry and urinary calcium and saturation.

Renal stone disease is a common problem in patients with spinal cord injury. The factors responsible are thought to include hypercalciuria and chronic urinary infection. There have, however, been no comparative studies of urinary composition in patients with neuropathic bladder with and without renal stone disease. Blood, 24-h urine samples and circadian variation of urinary composition were studied in male paraplegic patients with renal stone disease accompanied by urinary infection and in similar patients without stone disease with and without urinary infection. Two categories of stone patients were recognised, according to whether or not urinary oversaturation with magnesium ammonium phosphate occurred. The urine of all stone patients was oversaturated with calcium phosphate for part of each day. Urinary calcium was elevated in 16% and plasma urate in 30% of the paraplegics studied.

The effect of oral acetohydroxamic acid on urinary saturation in stone-forming spinal cord patients.

Chronic urinary infection is thought to be a major factor in the causation of urinary calculi in paraplegic patients. Acetohydroxamic acid is reported to be effective in some patients for the management of this type of stone disease, but there have been no studies of urinary saturation levels during therapy with this drug. In this study 10 patients received oral acetohydroxamic acid for seven days. Marked lowering of urinary pH and ammonium levels were observed, but decreases in urinary saturation were small. The administration of acetohydroxamic acid resulted in increased urinary excretion of magnesium and phosphate, effects that have not previously been reported.