Enhanced glucose-dependent glucagon-like peptide-1 and insulin secretion in Crohn patients with terminal ileum disease is unrelated to disease activity or ileal resection.

BACKGROUND: Enhanced secretion of glucagon-like peptide-1 (GLP-1) has been reported in patients with Crohn disease (CD). However, the correlation between the enteropancreatic axis and the activity of CD remains unclear. METHODS: Plasma glucose, insulin, GLP-1 levels and insulin sensitivity were determined before and after oral glucose tolerance tests in 13 patients with CD of the terminal ileum, in 13 patients after resection of the terminal ileum and in 7 healthy controls. Basal and stimulated insulin sensitivities were determined using the homeostasis model assessment (HOMA) and the insulin sensitivity index (ISI) methods, respectively. RESULTS: Basal and stimulated glucose levels were comparable in patients and controls. The peak stimulated GLP-1 secretion was significantly higher in the patient group compared to controls: 12.2 +/- 1.24 pM/L and 8.1 +/- 1.72 pM/L, respectively, P=0.03. This was associated with 52% increased overall insulin secretion in the patients' group as compared to controls (P=0.007) and a higher peak insulin response: 63.5 +/- 9.69 mU/L and 41.5 +/- 6.85 mU/L for patients and controls, respectively, P=0.04. Operated patients had similar GLP-1 levels but higher peak and overall insulin secretions compared with those in non-operated patients (P=0.01). Fasting and stimulated insulin sensitivities were reduced only in patients with ileal resection as compared to controls: P=0.01 and P=0.05, respectively. No correlation was found between the CD activity index and GLP-1 or insulin secretion. CONCLUSIONS: CD of the terminal ileum is associated with enhanced glucose-dependent GLP-1 secretion, which is unrelated to disease activity or ileal resection.

Echocardiogram in sternal fracture.

We reviewed the records of 50 consecutive patients presenting with sternal fracture after blunt chest trauma. The relationships between electrocardiogram, creatine kinase MB isoenzyme and echocardiogram (ECHO) were assessed in reference to myocardial contusion. Eleven patients (22%) had 1 or more abnormal cardiac tests but only 3 (6%) had clinically symptomatic myocardial contusion. Seven (22.5%) out of 31 ECHO studies revealed pericardial effusion which was not associated with the severity of all other associated injuries. The incidence of an abnormal ECHO study in patients with isolated sternal fracture was similar to that of patients who suffered multiple injuries. In 5 patients with pericardial effusion, this finding was not associated with any other abnormal tests and was regarded as of no clinical cardiac significance. On the other hand, a myocardial contusion was shown by ECHO examination only while echocardiogram and creatine kinase MB tests remained normal in that patient. We suggest that the ECHO should be used as a diagnostic and triage tool in every patient with sternal fracture associated with other injuries. However, patients with "benign" pericardial effusion can be discharged as soon as their medical condition improves regardless of other associated injuries.

Toxic epidermal necrolysis associated with acetaminophen ingestion.

OBJECTIVE: To report a case of toxic epidermal necrolysis (TEN) associated with acetaminophen ingestion. SUMMARY: A seven-year-old girl developed TEN after acetaminophen ingestion. The diagnosis was based on clinical evaluation and skin biopsy. A later acetaminophen challenge, undertaken by an allergist who questioned the diagnosis, resulted in a similar skin reaction. DISCUSSION: TEN is a severe disease with a high mortality rate. TEN may be either idiopathic or associated with several clinical conditions, such as viral infections, autoimmune disorders, malignancy, and drug hypersensitivity. Because of the rarity of its association with acetaminophen, the diagnosis in our patient was questioned by an allergist who performed an oral acetaminophen rechallenge test despite the potential risk. This caused a severe skin reaction that required rehospitalization. CONCLUSIONS: TEN can be caused by over-the-counter medications such as acetaminophen. Rechallenge with the causative drug carries a risk of severe complications and should be avoided.

Metabolism of water, sodium, potassium, and chlorine by high yielding dairy cows at the onset of lactation.

We studied the balance of Na+, K+, Cl-, and water in six high yielding (> 39 kg/d of milk) cows between wk 2 to 1 prepartum and at 2 and 7 wk postpartum during winter in Israel. Cows were fed complete diets; Na+ and Cl- contents exceeded dietary recommendations, and K+ content was equal to dietary recommendations. Milk yield was related positively and significantly to retention of Cl- and K+, indicating that ions that are the main constituents of sweat can limit the ability of cows to express full genetic potential. The highest ion retention was recorded for cows that had the highest dry matter intake and, hence, the highest ion intake. Retention of Cl- was highest for cows that were most efficient in retaining Cl- in the kidney. In hot climates, increasing the concentrations of ions in the diet of early lactation cows according to the actual dry matter intake could prevent or reduce the severity of ion deficiencies. Water turnover rate of the cows was dependent on dry matter intake, milk yield, and respiratory-cutaneous water loss. The milk-free water balance (water turnover rate minus water secreted in milk) could be very efficiently predicted for lactating and nonlactating cows by the following equation: milk-free water balance (kilograms per day) = digestible energy intake (megacalories per day) x 0.58 + respiratory-cutaneous loss (kilograms per day) x 0.97 (n = 18; R2 = 0.97). This formula provides a tool to assess the evaporative-cutaneous water loss from feed and water intake measurements to evaluate the severity of heat stress.

Digestibility by dairy cows of monosaccharide components in diets containing wheat or ryegrass silages.

Digestibility by dairy cows of monosaccharide constituents in rations based on wheat or ryegrass silage as the sole roughage component was examined in this study. Six cows in early lactation were divided into two groups with similar performance data at the onset of the experiment and fed for ad libitum intake for two 28-d periods in a change-over design. Cows were fed a TMR of concentrate plus either wheat or ryegrass silage, contributing 19% of silage NDF in the TMR. Digestibilities of ration DM and total carbohydrate were 3.3 and 3.1 percentage units higher, respectively, for ryegrass than for the wheat silage. The digestibility of ration NDF was 64.1% in ryegrass silage and 49.6% in wheat silage. The trend was similar for digestibilities of NDF monosaccharide components. Ration NDF carbohydrate digestibility was 74.8% for ryegrass silage versus 59.7% for wheat silage. For both TMR, the digestibility of NDF xylose was lower than that for NDF glucose and arabinose. Based on carbohydrate digestibility, ryegrass silage can be considered to be a successful roughage alternative for wheat silage in TMR for lactating cows.

Progressive systemic sclerosis sine scleroderma in a child presenting as nocturnal seizures and Raynaud's phenomenon.

Progressive systemic sclerosis sine scleroderma, as well as neurological manifestations of progressive systemic sclerosis are rare in adult-onset cases. Neither have been reported in children with progressive systemic sclerosis, either separately or together. We describe a six-year-old girl with nocturnal seizures and Raynaud's phenomenon of three years' duration. She died of cardiopulmonary sclerosis without ever fitting the required criteria of systemic sclerosis. Nailfold capillaroscopy revealed the specific "scleroderma-pattern" and provided the only clue for a diagnosis of progressive systemic sclerosis, confirmed eventually by skin biopsy.

Is cord blood erythropoietin a marker of intrapartum hypoxia?

A sensitive assay was used to compare the biological activity of cord serum erythropoietin in two groups of infants born with or without labor-induced hypoxia. The mean cord serum erythropoietin activity in 161 infants delivered after vaginal labor was 116 +/- 36 mU/mL, and was indistinguishable from that observed in 23 infants delivered by preplanned, elective cesarean section, 114 +/- 12 mU/mL (P = .75). The bioassay measured effective erythropoietin activity, including the contribution of potentiators in serum. These results indicate that duration and intensity of labor are insufficient to cause a significant increase in effective erythropoietin activity.

Eicosanoids content in small intestinal mucosa of children with celiac disease.

Celiac disease (CD) is characterized by diarrhea, growth retardation, and weight loss in genetically susceptible subjects on a gluten-containing diet. The exact pathogenesis of CD is still obscure, but it is considered to be immunologically mediated. We have previously shown elevated prostaglandin E2 (PGE2) and thromboxane B2 (TxB2) content in small intestinal mucosa obtained from active celiac children. In the present study, we found significantly elevated PGE2, leukotriene B4 (LTB4), and leukotrienes C4, D4, and E4 (LTC4D4E4) content in small bowel mucosa from children suffering from CD on a gluten-containing diet in comparison to control subjects. PGE2 was 25,278 +/- 7,761 vs. 4,478 +/- 426 pg/mg of protein (mean +/- SEM), respectively. LTB4 was 8,807 +/- 3,706 vs. 403 +/- 63 pg/mg of protein (mean +/- SEM), respectively. LTC4D4E4 was 15,369 +/- 4,085 vs. 2,998 +/- 279 pg/mg of protein (mean +/- SEM), respectively. We conclude that the elevated content of arachidonic acid metabolic products via cyclooxygenase and lipoxygenase pathways may contribute to the diarrhea and may be involved in the pathogenesis of mucosal injury.

Atrial tumors--surgical experience of 9 cases.

Nine patients underwent surgical removal of intracardiac tumor during a 12-year period. The mean age of the five women and four men was 57 years (range 40 to 69). Eight of the nine patients were operated on in the last four years of the study period. The interval from onset of symptoms to surgery averaged 18.3 months. Clinical presentation varied significantly, reflecting mechanical, embolic and constitutional effects of the intracardiac mass. Echocardiography was the noninvasive procedure that contributed most to preoperative diagnosis, confirming presence of an intracardiac tumor in seven of the eight examined patients. Of the nine intracardiac tumors, seven were myxomas (6 left atrial and 1 right atrial), one was a primary left atrial liposarcoma and one a right atrial metastasis from an anaplastic carcinoma of the kidney. No patient died during or immediately after the operation. The two patients with malignant tumor died, two months and two years postoperatively, from progression of the basic disease. In neither case, however, was atrial recurrence of tumor found at autopsy. Of the seven surviving patients, five are symptom-free after observation periods averaging 34 months (range 2 months to 12 years). The other two still have signs of mild congestive heart failure. No recurrence of atrial myxoma has so far been detected.

Left ventricular rupture after mitral valve replacement. Report of two cases and a review of the literature.

Rupture of the left ventricle following mitral valve replacement occurred in 2 women among 520 patients (0.4%) during a 17-year-period at the Beilinson Medical Centre. In one patient, a delayed, type II rupture, followed by immediate exanguination, resulted from a 31 mm cloth-covered Starr-Edwards prosthesis inserted in a normal sized left ventricle. In the second patient, an intra-operative type I rupture occurred as a result of an over-zealous resection of a heavily calcified valve and annulus. Repeated attempts at surgical repair were unsuccessful. A review of 46 previously reported cases revealed several other factors that might be responsible for this complication which carries a 40-100% mortality rte, depending on whether it is diagnosed intra-operatively or in the immediate postoperative period. These factors and the variety of surgical approaches used for the repair of this grave complication are discussed.

Fertility of dairy heifers given a commercial diet free of beta-carotene.

1. Dairy heifers given concentrates including vitamin A and wheat straw from 7 to 17 months of age had an average plasma beta-carotene concentration of 20--60 micrograms/l. Control heifers given the same diet but supplemented with beta-carotene had a beta-carotene plasma concentration of 630--2190 micrograms/l. 2. In contrast to previous findings no differences in duration of standing oestrus, length of oestrous cycle, plasma progesterone and luteinizing hormone (LH) concentrations and interval between LH peak and ovulation were observed between the groups. All the heifers conceived after one or two inseminations; conception rate being 69% for heifers given a diet free of beta-carotene and 78% for the controls. 3. Average rate of growth of heifers not supplemented with beta-carotene was 0.75+/-0.02 kg/d v. 0.81+/-0.02 kg/d for the controls (P less than or equal to 0.02). 4. The possible reasons for the discrepancy between present and previous findings are discussed.

Assay and use of magnesium ferrite as a reference in absorption trials with cattle.

Magnesium ferrite, an inert ferrimagnetic material, was introduced as reference substances in absorption trials with ruminants. A method for assaying magnesium ferrite was based upon the difference between the weight of the test material on an analytic balance and that of the same material weighed below a permanent magnet. Four heifers in two pairs were in a feeding experiment lasting for 6 wk divided into two 3-wk periods. Each animal received once daily 12 g magnesium ferrite and, as control, 12 g shredded paper impregnated with 4.2 g chromium oxide. The rations were composed of chopped wheat straw and concentrates, given twice daily, with a different straw-concentrate ratio for each group. The treatments were reversed after the first experimental period. Mean recoveries of magnesium ferrite and chromic oxide in total collection of feces were 103 and 90.2%. Mean absorption coefficients of organic matter calculated by total collection and by the ratios of magnesium ferrite and chromic oxide in feces taken from the rectum were 68.1, 70.1, and 65.7%. The method is simple and accurate and may replace methods involving time consuming chemical determinations.