The effects of hydrocortisone on systemic arterial blood pressure and urinary protein excretion in dogs.

BACKGROUND: Hypertension and proteinuria are commonly recognized in dogs with spontaneous hypercortisolism. There is, however, little information regarding the effect of exogenous glucocorticoids on blood pressure (BP) and proteinuria and whether these changes are reversible. HYPOTHESIS: Hydrocortisone administration increases systemic BP and urinary protein excretion, and these effects are reversible after hydrocortisone withdrawal. ANIMALS: Six control dogs and 6 dogs treated with hydrocortisone. METHODS: BP, urine protein : creatinine ratio (UPC), microalbuminuria (MALB), urine albumin : creatinine ratio (UAC), and urine gel electrophoresis were evaluated before, during, and after administration of hydrocortisone (8 mg/kg PO q12h for 12 weeks) or placebo. RESULTS: BP and UPC increased substantially during hydrocortisone administration from 123 mmHg (range 114-136 mmHg) and 0.17 (0.15-0.28) to a maximum of 143 mmHg (128-148 mmHg) and 0.38 (0.18-1.78), respectively, on day 28. MALB developed in 4 dogs and UAC significantly increased in all dogs during hydrocortisone administration with the maximum on day 84. Both increases in BP and proteinuria were reversible and completely resolved within 1 month after stopping hydrocortisone administration. SDS-AGE revealed the proteinuria to be primarily albuminuria with a pronounced increase during hydrocortisone treatment. Furthermore, a protein of 25-30 kDa was found in male dogs, identified by mass spectrometry to be arginine esterase, the major secretory prostatic protein. CONCLUSIONS AND CLINICAL IMPORTANCE: Long-term hydrocortisone treatment results in significant but only mild increases in systemic BP and urinary protein excretion, which are both reversible within 1 month after discontinuation of hydrocortisone.

A second acromelanistic allelomorph at the albino locus of the Mongolian gerbil (Meriones unguiculatus).

A new autosomal recessive coat color mutant in the Mongolian gerbil (Meriones unguiculatus) is described: chinchilla medium (symbol c(chm)). The mutant has typical acromelanistic features similar to those of several acromelanistic c locus mutants of other species of mammals. Previously a more severe form of acromelanism (c(h)c(h)) has been described in the Mongolian gerbil. The new allele shows to be allelic with this form. On a nonagouti background compound heterozygotes (aac(chm)c(h)) show an intermediate phenotype that is very similar to that of the Siamese mouse (Mus musculus) and rat (Rattus norvegicus). Homozygotes (aac(chm)c(chm)) display a very dark acromelanistic phenotype reminiscent of that of the sable rabbit (Oryctolagus cuniculus). The gray phenotype (gg) in the Mongolian gerbil resembles the albino locus phenotype chinchilla (c(ch)c(ch)) in mice. We show that the new mutant is not allelic with gray. Fertility and viability of the new mutant are within normal range.

[Klippel-Trenaunay syndrome as a rare cause of carpal tunnel syndrome--case report]. / Das Klippel-Trénaunay-Syndrom als seltene Ursache eines Karpaltunnelsyndroms--Fallbericht.

The case of a 12-year-old girl with Klippel-Trénaunay syndrome and the signs of median nerve entrapment is reported. A cavernous haemangioma surrounding the median nerve is thought to be responsible for the carpal tunnel syndrome through mechanical compression and ischemic damage to the nerve due to the changed haemodynamic situation in the carpus.

Diagnosis and hazards of unexpected diaphragmatic hernias during colonoscopy: report of two cases.

Two cases of diaphragmatic hernias are reported. Both cases were previously undiagnosed and were found during diagnostic colonoscopy. In one case sudden respiratory distress occurred during the endoscopic procedure owing to a barotraumatic perforation in a left-sided hernia with tension pneumothorax. The diagnoses were made by fluoroscopy without delay. Endoscopists should be aware of the possible occurrence of diaphragmatic hernias and their risk as life-threatening complications. To avoid such dangerous complications access to X-ray facilities with fluoroscopy is recommended in endoscopic units where colonoscopies are performed.

[When competence and creativeness coincide]. / Wenn Kompetenz auf Kreativität trifft.

Hepatitis B is not perceived as a serious health hazard in the general population, even less so in adolescents. Specific information in a clear and understandable language is crucial to obtain good acceptance of vaccination against hepatitis B. Adolescents are the best mediators to communicate this message to persons of their age as they take into account the group's specific sensitivity, culture and language. A close collaboration between youngsters and experts is needed to produce attractive, precise and correct information concerning the prevention of hepatitis B infections.

Stages of change, decisional balance, and self-efficacy across four health behaviors in a worksite environment.

PURPOSE: This study examined differences in decisional balance and self-efficacy scores across the five stages of change and across four health behaviors (exercise, protection from sun exposure, smoking, and dietary fat consumption), and explored the relationship between the frequency of subjects at each stage across four health behaviors. DESIGN: Data for this study were collected as part of a health behavior survey of employees. SETTING: The study was conducted in a municipal government worksite in Arizona. SUBJECTS: A total of 393 employees completed the survey. The sample was predominantly white (84.9%) and male (64.4%), with an average age of 42.2 years and a median annual household income of between $40,000 and $59,999. MEASURES: Previously validated questions to measure stages of change, decisional balance, and self-efficacy were administered, along with questions about demographic variables. RESULTS: Significant differences were found for decisional balance and self-efficacy scores across the five stages of change, but they were not significantly different between the four health behaviors. A minority of subjects (18.6%) were in the same stage of change for all four health behaviors. CONCLUSIONS: This study provides preliminary evidence that there is considerable stage specificity across multiple health behaviors. Because employees at each stage of change possess differences in terms of their pros, cons, and self-efficacy, wellness programs need to focus on stage-specific interventions.

Clinical manifestations of lost gallstones after laparoscopic cholecystectomy: a case report with review of the literature.

Laparoscopic cholecystectomy has become the preferred treatment for patients with symptomatic gallstones. During this procedure, perforation of the gallbladder with spillage of stones into the peritoneal cavity is not uncommon. Finding and removing all of the spilled gallstones can be laborious and is often avoided. Left in the peritoneal cavity, however, the stones may lead to intraperitoneal abscess formation, which may require a second procedure. We report here on a patient with an intraperitoneal abscess located between the right liver lobe and the anterior abdominal wall, which contained a large gallstone (4 cm3), found 3 months after an undetected stone spillage during laparoscopic cholecystectomy. Healing was achieved after conventional laparotomy, removal of the gallstone, and surgical drainage of the abscess cavity. The review of the literature emphasizes the clinical manifestations of this rare laparoscopic complication.

[Osseous extensor tendon rupture of the finger joint: surgical technique and results]. / Der knöcherne Strecksehnenausriss am Fingerendglied: operative Technik und Ergebnisse.

Mostly mallet finger can be treated conservatively. In cases of fracture of the distal phalanx open reduction and fixation is recommended. We favour the well-established cerclage, yet perform it in a more comfortable way with the use of cannulated drilling. This technique was applied on 13 patients even with lesions several weeks old. The evaluation 5-16 months postoperatively based on radiological, clinical and subjective criteria. We present the technique and the results followed by the discussion of the advantages over conservative and other operative managements.

[Management of complete acromioclavicular dislocation with resorbable fixation material (PDS cord)]. / Versorgung der kompletten AC-Luxation mit resorbierbarem Fixationsmaterial (PDS-Kordel).

The complete acromioclavicular dislocation impairs the motility of the shoulder girdle. The surgical transfixation of the AC-joint with a screw, with K-wires or with special plates has a quite high complication rate and requires a second operation. We suggest the dynamic augmentation of the sutured ligaments with a coracoclavicular and an acromioclavicular PDS-cord cerclage. The paper presents the results of a follow-up examination of 10 patients.

The effectiveness of medical self-care interventions: a focus on self-initiated responses to symptoms.

Medical self-care has always been a primary means of caring for health problems. Educational materials and interventions have been used for centuries to improve the quality of medical self-care. However, relatively few studies have been undertaken to examine the effects of these interventions on the health of the individual or on the use of professional services. This review was undertaken to provide (1) a summary of studies describing the practice of medical self-care and (2) a summary of studies evaluating the impact of medical self-care interventions to improve self-initiated responses to symptoms. In addition, we summarize the effectiveness of those self-care interventions.

Enhanced susceptibility of blood monocytes from patients with pulmonary tuberculosis to productive infection with human immunodeficiency virus type 1.

Blood monocytes from patients with active pulmonary tuberculosis and age-matched healthy purified protein derivative-reactive donors were infected with human immunodeficiency virus type 1 (HIV-1)JR-FL in vitro to assess their susceptibility to productive infection by HIV-1. HIV-1 p24 levels (enzyme-linked immunosorbent assay) in supernatants of infected cells from patients with tuberculosis, albeit variable, were significantly higher at days 10-20 of culture; the maximum levels of p24 antigen were greater in supernatants of HIV-1-infected monocytes from patients than maximum levels for controls (p < 0.05). The maximum increment in p24 levels for patients also exceeded that for controls (p < 0.05). Entry of HIV-1 and/or initiation of reverse transcription, measured by polymerase chain reaction using HIV-1 R/U5 primer pairs, was variable and low in infected monocytes from both patients and controls, and did not correlate with HIV-1 p24 levels. The frequency of infected cells as assessed by endpoint dilution viral cultures was similar for both groups. Therefore, blood monocytes from patients with active tuberculosis can develop a highly productive infection with HIV-1 that does not appear to be due to enhanced HIV entry or higher frequency of infected cells. The enhanced susceptibility may result directly from activation of monocytes by exposure to Mycobacterium tuberculosis and its products in situ.

Colonial morphotype as a determinant of cytokine expression by human monocytes infected with Mycobacterium avium.

Mycobacterium avium is an intracellular pathogen that causes disseminated infection in patients with AIDS. Colonial morphotype (smooth-transparent (SmT) vs smooth-domed (SmD)) is a key determinant of virulence in mice and the capacity for replication in human monocytes. Some cytokines (IL-1 and IL-6) promote, whereas others (IFN-gamma and TNF) inhibit intracellular M. avium growth. The specific factors that determine virulence of M. avium, however, are not clear. In this study, we examined cytokine expression by human monocytes stimulated with isogeneic cloned isolates of M. avium. Monocytes were prepared from healthy donors and cultured with or without isogeneic M. avium for up to 7 days. Cytokine levels (IL-1, IL-6, and TNF-alpha) in monocyte supernatants and cell lysates were measured by immunoassay using an ELISA. The expression of cytokine mRNA by monocytes infected with M. avium also was determined by extracting total RNA and subjecting it to Northern blot analysis. Optimal cytokine release occurred at 24 h. SmD induced higher levels of the following cytokines in supernatants than SmT: IL-1 alpha (140 +/- 32 (mean +/- SE) vs 47 +/- 16 pg/ml, p < 0.02), IL-1 beta (4.0 +/- 0.9 vs 1.7 +/- 0.5 ng/ml, p < 0.01), and TNF-alpha (2725 +/- 546 vs 1464 +/- 409 pg/ml, p < 0.01). IL-6 production was comparable for both strains. SmD and SmT isolates induced comparable levels of steady state mRNA for IL-1 beta, TNF, and IL-6. Pulse-chase analysis indicated that differences in cytokine expression between SmT and SmD occurred in monocyte lysates at the earliest time point (immediately after pulse-labeling). The dissociation of the expression of specific mRNA from production of IL-1 and TNF suggests that translational capacity for the expression of certain cytokines was reduced by the more virulent SmT. Differential induction of cytokine may be a factor in the pathogenicity of M. avium strains isolated from patients with AIDS.

[User's arguments in the use of a hospital emergency unit]. / Razones del usuario en la utilización de un servicio de urgencias hospitalario.

300 cases admitted in a hospital Emergency Unit are studied, corresponding to two weeks of June 1989, with the aim to know user's characteristics and pathology shown. Through a survey addressed to the patient, or person accompanying him/her, it is intended to know the reasons which motivated the election of this type of service. Predominant pathology is the one which groups lesions and adverse effects (52%) and are younger age groups the ones who consult more frequently. Most part of patient (80%) show up with no previous inform or document and 89% of admitted patients were sent to their homes. Geographical proximity explains in most cases the election of the Emergency Unit. Reasons vary according to age, diagnostic and different circumstances. For example during morning hours, and among patients who attend based on their initiative, "familiarity" is the most important reason to adopt the decision to attend Emergency Unit.

Induction of expression of monocyte interleukin 1 by Hageman factor (factor XII).

The results reported here indicate that activated species of Hageman factor (HF, factor XII), a protein that mediates blood clotting, fibrinolysis, and activation of the complement cascade, induce elaboration of interleukin 1 (IL-1) by human monocytes. Augmentation of IL-1 production in mononuclear cell cultures was observed when HF was present along with lipopolysaccharide (LPS) but was not observed with HF alone. Furthermore, antiserum to HF abrogated the enhancement of IL-1 in cultures containing HF and LPS. Total IL-1 activity, which represents secreted and cell-associated IL-1, was enhanced in LPS-stimulated mononuclear cultures by HF. In the absence of LPS, the initial activation product of HF, HFa, which contains the serine protease enzyme activity and the surface-binding domains of the protein, induced IL-1 beta protein and mRNA. In the presence of LPS, the enzymatic moiety (HFf), which is also contained in HF and HFa, amplified IL-1 production. Induction and amplification of monocyte IL-1 by HF provides further evidence for establishing a role for HF in the acute-phase reaction and the cellular immune response.

[Long-term results using a Swanson silastic endoprosthesis of the metatarsophalangeal joint of the great toe. Discrepancy between clinical and radiologic findings]. / Langzeitergebnisse mit der Silastik-Endoprothese nach Swanson am Grosszehengrundgelenk. Diskrepanz zwischen Klinik und radiologischem Befund.

53 patients underwent 68 Swanson's Silastic prosthesis implantations in great toes from 1979-1984. 51 patients (96%) with 66 implantats were followed up from 1 to 7 years. The results of self-judgement and clinical examination at control were favourable, in contrast to the large number of unfavourable radiologic findings at control. Statistical analysis revealed a significant association between the number of weared prostheses with narrowing or fragmentation and increasing follow-up time (p = 0.04), but no significant association between the results of self-judgement and clinical examination and follow-up time.