Effects of time of day, gender, and menstrual cycle phase on the human response to a water load.

Estrogen and progesterone interference with renal actions of arginine vasopressin (AVP) has been shown. Thus we hypothesized that women will have a higher water turnover than men and that the greatest difference will be during the luteal phase of the menstrual cycle. Seven men (32 +/- 3 yr) and six women (33 +/- 2 yr) drank 12 ml water/kg lean body mass on different days at 0800 and at 2000 following 10 h of fast and a standardized meal at 0600 and 1800. Women participated on days 4-11 and 19-25 of the menstrual cycle. Initial urine and plasma osmolalities and urine flow rates were similar in all experiments. The cumulative urine voided over 3 h following the morning drink was less in men (73 +/- 12% of the water load) compared with women in either the follicular (100 +/- 3%) or luteal phases (102 +/- 10%) of the menstrual cycle. Nighttime values (30-43% of the water load) were lower in all experiments and were not different between sexes or menstrual cycle phases. Plasma AVP was higher at night and may contribute to this diurnal response. The data are generally consistent with the stated hypothesis; however, possibly owing to the greatly reduced urine flow in both sexes at night, a difference between sexes was not observed at that time.

Operation tropic refuge: the East Wood rescue.

The U.S. Coast Guard rescued 525 Chinese nationals and ten Indonesian crewmen from the disabled motor vessel East Wood. They were participating in a human smuggling operation. Subjected to a trying ordeal at sea, these individuals were at great risk to life and health but survived remarkably well because of their good health, age, and mutual cooperation. The U.S. military organized the joint task force, Operation Provide Refuge, to provide humanitarian aid. The task force rapidly mobilized resources to support camp development on Kwajalein Island and provide nutrition and health care to the stranded travelers. Preventive Medicine personnel, called in at the beginning of the operation, helped develop a healthy campsite, which contributed to a relatively uneventful refugee experience. Close liaison with the local medical resources on Kwajalein was essential to the success of the operation.

Doppler analysis of hemodialysis grafts: resistive index as a predictor of stenosis.

A series of six hemodialysis vascular access patients was evaluated with duplex Doppler sonography and angiography to identify Doppler sonographic parameters that are predictors of venous outflow stenosis. This preliminary series indicates that no venous outflow stenosis was present angiographically when the resistive index gradient across the venous anastomosis is less than or equal to zero and a significant venous outflow stenosis (50 to 100%) was present when the resistive index gradient is 0.15 or greater (P = 0.002, r = 0.963). Doppler acquisition of resistive index gradients across regions of venous outflow is a promising, noninvasive means of rapid radiologic evaluation of hemodialysis graft patients, especially when the need for angiography is equivocal.

A giant renal artery aneurysm diagnosed post partum.

We report a case of a 5.8 cm. right renal artery aneurysm diagnosed intact 8 weeks post partum. Rupture of a renal arterial aneurysm during pregnancy is a rare but well described catastrophic event. There are no previous reports of an intact renal artery aneurysm diagnosed either ante partum or post partum. To our knowledge, this also represents the largest reported renal artery aneurysm. The aneurysm was repaired successfully with kidney salvage and closure of the fistulous connection to the renal vein.

The protean manifestations of hemorrhagic fever with renal syndrome. A retrospective review of 26 cases from Korea.

Twenty-six cases of hemorrhagic fever with renal syndrome from 1981 to 1986 were retrospectively reviewed to determine the scope of clinical presentation and the unique complications of the illness. The diagnosis was confirmed by detection of Hantaan virus antibody in 25 cases and by characteristic autopsy findings in 1 case. The illness could be classified into three distinct clinical subgroups. Fever was universally present. Two patients presented with intractable shock and diffuse hemorrhage and died within 6 days from multi-organ system failure, mimicking the clinical picture of overwhelming sepsis. Eighteen patients presented with acute renal failure with an illness lasting a mean of 21 days (range, 10 to 36 days). Resolution of thrombocytopenia heralded recovery of renal function. At discharge, the serum creatinine level was normal in 13 patients; 5 patients had evidence of minimal renal dysfunction. Acute pulmonary edema requiring hemodialysis and retroperitoneal hemorrhage were the major complications in this subgroup. Six patients had an undifferentiated febrile illness with normal renal function. Fever, thrombocytopenia, abnormal urinalysis, hypertransaminasemia, and a benign clinical course characterized the third clinical pattern. The recent availability of serodiagnostic methods to detect Hantavirus group antibody facilitates the diagnosis of hemorrhagic fever with renal syndrome. Application of this test in the described clinical settings will identify unsuspected cases, broaden the knowledge of the geographic distribution of Hantavirus infection, and increase physician awareness of its protean manifestations.

Noncompliant hemodialysis patients. A biopsychosocial approach.

Noncompliance to fluid restrictions is remarkably common and difficult to treat in hemodialysis patients. Psychosocial variables have not been convincingly demonstrated to correlate with fluid noncompliance. Fluid overloading tends to begin early in the course of dialysis treatments and remains remarkably stable over time. This maladaptive behavior on the part of so many dialysis patients could be promoted by abnormalities in the renin-aldosterone-angiotensin system or other abnormalities in the homeostatic mechanisms that regulate water metabolism. Hypotheses related to addictive behavior and milieu variables are also discussed. Recommendations include using a nonmoralistic approach, flexibility in dialysis schedules, and psychological intervention at the onset of dialysis.

Hemoperitoneum during continuous ambulatory peritoneal dialysis: a possible complication of radiation induced peritoneal injury.

Hemoperitoneum requiring surgical exploration developed in association with an indwelling chronic peritoneal dialysis catheter. Major intra-abdominal hemorrhage in continuous ambulatory peritoneal dialysis (CAPD) has not been previously reported. Radiation therapy for carcinoma of the bladder and subsequent radiation induced peritoneal injury appears to have predisposed this patient to develop catheter-related trauma and hemorrhage. Antecedent radiation therapy with its possible deleterious effects on the peritoneal membrane may subject potential CAPD patients to unique risks and should be considered in the decision to choose CAPD as a form of treatment for end stage renal disease.

Goodpasture's syndrome--local and diffuse deposition of antibody in glomerular basement membrane. Case report.

An unusual case of Goodpasture's syndrome in a 22 year old white female is presented. The diagnosis of antiglomerular basement membrane disease was made on the basis of circulating anti-GBM antibodies in the presence of linear IgG deposits along the glomerular basement membrane by immunofluorescent microscopy. An additional finding was the presence of discrete granular subepithelial deposits on electron microscopy. Possible pathogenetic mechanisms are discussed.