Symptomatic unilateral idiopathic giant bullous emphysema : a case report.

BACKGROUND: Idiopathic Giant Bullous Emphysema (or Vanishing Lung Syndrome) is a rare condition which is usually associated with male gender, active smoking and underlying emphysematous disease. We present an unusual case of a giant bulla occurring in the absence of these risk factors. CASE PRESENTATION: A 54-year-old woman presented to the respiratory outpatient clinic with gradually worsening left sided chest discomfort, which was most marked during a recent flight. She had no significant dyspnoea or other symptoms. She had a remote 5-pack-year smoking history. Chest X-Ray revealed a large hyperlucent area in the left upper lobe. CT Thorax found this to be an isolated bulla occupying more than one-third of the hemithorax. The remaining lung parenchyma was normal. A diagnosis of Idiopathic Giant Bullous Emphysema was made. The patient was referred for VATS (Video-assisted thoracoscopic surgery) bullectomy which was carried out without complication. Her symptoms resolved completely following the operation. CONCLUSIONS: This is an unusual case of a solitary giant bulla occurring without major risk factors or underlying lung disease. VATS bullectomy was shown to be an effective therapeutic option, allowing re-expansion of compressed lung tissue and complete resolution of symptoms.

Effects of Running Wheel Activity and Dietary HMB and ß-alanine Co-Supplementation on Muscle Quality in Aged Male Rats.

OBJECTIVE: Loss of skeletal muscle function is linked to increased risk for loss of health and independence in older adults. Dietary interventions that can enhance aging muscle function, alone or in combination with exercise, may offer an effective way to reduce these risks. The goal of this study was to evaluate the muscular effects of beta-hydroxy-beta-methylbutyrate (HMB) and beta-alanine (ß-Ala) co-supplementation in aged Sprague-Dawley rats with voluntary access to running wheels (RW). METHODS: Aged (20 months) rats were housed with ad libitum access to RW while on a purified diet for 4 weeks, then balanced for RW activity and assigned to either a control or an experimental diet (control + HMB and ß-Ala) for the next 4 weeks (n = 10/group). At the end of the study, we assessed muscle size, in situ force and fatigability in the medial gastrocnemius muscles, as well as an array of protein markers related to various age- and activity-responsive signaling pathways. RESULTS: Dietary HMB+ß-Ala did not improve muscle force or fatigue resistance, but a trend for increased muscle cross-sectional area (CSA) was observed (P = 0.077). As a result, rats on the experimental diet exhibited reduced muscle quality (force/CSA; P = 0.032). Dietary HMB+ß-Ala reduced both the abundance of PGC1-α (P = 0.050) and the ratio of the lipidated to non-lipidated forms of microtubule-associated protein 1 light chain 3 beta (P = 0.004), markers of mitochondrial biogenesis and autophagy, respectively. Some alterations in myostatin signaling also occurred in the dietary HMB+ß-Ala group. There was an unexpected difference (P = 0.046) in RW activity, which increased throughout the study in the animals on the control diet, but not in animals on the experimental diet. CONCLUSIONS: These data suggest that the short-term addition of dietary HMB+ß-Ala to modest physical activity provided little enhancement of muscle function in this model of uncomplicated aging.

Beating the IPS blues.

The negative effects of the interim payment system (IPS) are just reaching their peak. The number of providers closing their doors because of IPS could leave elderly and frail people without access to needed services. In just one year, home care has gone from being the darling of Wall Street and the health care industry to the pariah. However, the aspect of IPS that has not been extensively reported is the human cost to the home care community.

Genetic characterization of American and Western Samoans.

The Samoan islands were politically separated into American Samoa and Western Samoa in the early 1900s. Economic modernization is far more extensive in American Samoa. However, the Samoan archipelago has maintained a remarkable degree of sociocultural homogeneity, including intermarriage. The sociocultural exchanges presumably led to genetic homogeneity between the two Samoas. Detailed genetic comparisons and characterizations of Samoans are scanty, however. As part of a multidisciplinary study of modernization and cardiovascular risk factors in adults, we analyzed nine hypervariable nuclear DNA (HVR) and four serum protein polymorphisms in the two Samoan groups. The average heterozygosities at both DNA and serum protein loci are comparable in the two groups. As expected, the HVR loci reveal a high degree of variability (heterozygosity 30-87%) compared with the serum protein loci (heterozygosity 1-52%). A large proportion of alleles at the HVR loci, ranging from 50% to 100%, are shared between American and Western Samoa. With the exceptions of the D1S80 locus in American Samoa and the D13S118 locus in Western Samoa, the genotype distributions at all loci conform to their respective Hardy-Weinberg expectations. Sporadic occurrence of the F13B*2 allele at the F13B locus in Samoans indicates a low level of European admixture because this allele is unique to Europeans. The calculated zero values of kinship coefficients and standard genetic distances indicate minimal population differentiation between the two Samoan groups.

Recovery of fecal chromium used as a digestibility marker in cattle.

Chromium content of fecal samples that were mixed with Cr-mordanted rumen contents at 5 or 10 g/200 g feces in Experiment 1 and at 5 or 10 g/300 and 200 g feces in Experiment 2 was determined by atomic absorption spectroscopy. Recovery of Cr was estimated after digesting fecal samples, which were frozen fresh and later thawed or dried in either a forced draft oven at 60 degrees C or in a microwave oven in Experiment 1. Experiment 2 evaluated the efficacy of each of three methods of digestion in recovery of Cr from fecal samples. Recoveries of Cr from feces were calculated relative to the Cr content of the Cr-mordanted rumen contents, which were determined by atomic absorption spectroscopy of samples digested with concentrated nitric acid in the presence or absence of the wetting agent Tween 80. Recovery of Cr from fecal samples frozen fresh and later thawed was greater than that from either forced draft oven or from microwave oven-dried samples, especially when the concentrated nitric acid digestion was used. Neither the double ashing procedure nor the digestion with the weaker nitric acid did not improve Cr recoveries from the samples.

An unusual case of Peutz-Jeghers syndrome in an infant.

An 11-month-old girl had an unusual history of colocolonic intussusception associated with polyps that prolapsed through the rectum. Several months thereafter, characteristic brownish-black pigment spots of the lips were noted. The histologic appearance of the polyps was consistent with that of the Peutz-Jeghers syndrome. To our knowledge, this is the youngest reported case of symptomatic Peutz-Jeghers syndrome.