Tonic sympathetic support of metabolic rate is attenuated with age, sedentary lifestyle, and female sex in healthy adults.

We recently demonstrated in young adult humans that the sympathetic nervous system contributes to the control of resting metabolic rate via tonic beta-adrenergic receptor stimulation. In the present follow-up study we determined the respective effects of age, habitual exercise status, and sex on this regulatory mechanism. Resting metabolic rate (ventilated hood, indirect calorimetry) was determined in 55 healthy sedentary or endurance exercise-trained adults, aged 18-35 or 60-75 yr (29 men and 26 women), before (baseline) and during the infusion of either a nonselective beta-adrenergic receptor antagonist (propranolol) or saline (control). Relative to baseline values, during beta-adrenergic receptor antagonism resting metabolic rate adjusted for fat-free mass was reduced to a lesser extent in older (mean +/- SE, -130 +/- 46 kJ/d) compared with young (-297 +/- 46) adults, sedentary (-151 +/- 50) compared with endurance exercise-trained (-268 +/- 46) adults, and women (-105 +/- 33) compared with men (-318 +/- 50; all P < 0.01). Reductions in resting metabolic rate during beta-adrenergic receptor antagonism were positively related to higher baseline resting metabolic rate and plasma catecholamine concentrations and negatively related to adiposity (all P < 0.05). Resting metabolic rate was unchanged in response to saline control in all groups. These results provide experimental support for the hypothesis that aging, sedentary living, and female sex are associated with attenuated sympathetic nervous system support of resting metabolic rate in healthy adult humans.

Sclerosing lobular hyperplasia of the breast after reduction mammaplasty.

Sclerosing lobular hyperplasia is a uncommon benign fibroproliferative lesion of the breast similar to a fibroadenoma. It usually presents as a mass in the outer quadrant of the breast of younger women. The authors report an atypical case of sclerosing lobular hyperplasia that presented as bilateral breast masses in an elderly woman after a reduction mammaplasty. Breast masses that develop after reduction are often a result of fat necrosis, internal scarring, or organizing hematomas. Those that do not resolve warrant open biopsy because they may represent malignant or benign neoplasms.

Pancreatic pseudotumor in an 11-year-old child: imaging findings.

BACKGROUND: An inflammatory pseudotumor is a benign, solid lesion of unclear etiology. Some authors believe it is a true neoplasm, while others consider it a post-infectious or post-traumatic process. It is most commonly found in the lung; an inflammatory pseudotumor of the pancreas is rare. This case report is the sixth of a pancreatic pseudotumor in a child. PATIENTS AND METHODS: An 11-year-old girl presented with obstructive jaundice due to a mass in the head of the pancreas. The mass was identified by sonography. This was confirmed by MRI and CT. The mass enhanced with gadolinium, but its enhancement at CT was similar to the remainder of the pancreas. RESULTS: At operation, a pancreatic inflammatory pseudotumor was totally resected.

Non-Hodgkin's lymphoma presenting as anasarca: probably mediated by tumor necrosis factor alpha (TNF-alpha).

Two patients presented with anasarca, fevers and sweats. Subsequent evaluation revealed aggressive lymphoproliferative disease. Both patients were treated with CHOP chemotherapy. One patient responded with spontaneous, vigorous diuresis and complete resolution of the edema. She relapsed two months later with recurrent edema that responded a second time to salvage chemotherapy. The second patient died of gram positive sepsis a week after diagnosis. As anasarca is an unusual presenting symptom of non-Hodgkin's lymphoma, we postulated that the malignant cells were secreting a cytokine that resulted in "vascular leakage" of fluid and development of diffuse edema. Several serum cytokine levels were tested. Both patients had elevated TNF-alpha levels, which could have been the cause of the edema; or there might be yet another unidentified mediator that was responsible for the anasarca. We report these two cases to bring to attention the unusual nature of this presentation.

Erythroleukemia of childhood and infancy: a report of two cases.

Two rare de novo cases are presented of pediatric erythroleukemia (EL), AML-M6 in a four-month-old (patient A) and four-year-old (patient B) African-Americans who presented to the Medical College of Georgia from 1989 to 1995. The clinical, morphologic, immunophenotypic and cytogenetic features of both patients are reviewed. The purpose of this study is to correlate the bone marrow morphology with the immunophenotypes and the karyotypes of the neoplastic cells. The patients were both female, presented with flu-like symptoms, and were noted to have hepatosplenomegaly on physical examination. The peripheral blood examination was significant for anemia (Hb 54 (A), 84(B)g/L), and thrombocytopenia (86 (A), 70(B) x 10(9)/L). The bone marrow contained 75 percent (A) and 76.8 percent (B) erythroblasts and showed myelodysplastic changes in the erythroid cell line. Cytochemical analysis was performed, and greater than 10 erythroblasts per 100 cells were periodic acid-Schiff positive. Immunophenotypes of the pretreatment bone marrow showed glycophorin-A, CD71, and CD11b positivity. The karyotypes of both patients contained complex (> 3 per clone) cytogenetic abnormalities. Our data suggest that the initial presentation and course of disease are different in adults and children. However, once the adult form reaches the acute leukemia stage, the laboratory findings are similar to those at initial presentation in pediatric EL.

Hair granuloma of the prostate.

We report the second case of so-called hair granuloma of the prostate in a transurethral resection specimen. We hypothesize that the hair was most likely embedded in bladder/neck/prostate tissue by an earlier perineal prostate needle biopsy.

A career ladder program designed by perioperative staff nurses.

Staff members at Baylor University Medical Center, Dallas, were dissatisfied with the existing clinical ladder program, so a committee of perioperative staff nurses was appointed to create a new program. The new program was based on a literature review and RN and management survey data. Under the new program, nurses must accumulate points to quality for or maintain clinical nurse levels I, II, or III. The point system recognizes many professional contributions that were ignored by the previous program.

Deep level transient spectroscopy for diodes with large leakage currents.

A Deep Level Transient Spectroscopy (DLTS) system is described for measuring deep levels in diodes exhibiting large leakage currents. A capacitance bridge employing the diode to be tested along with a dummy diode of similar characteristics is used. The DLTS spectrum of a leaky GaAs planar diode is measured and compared to experimental results obtained with two standard DLTS systems. It is shown that measurements with the standard systems are impossible in certain temperature ranges because of overloading problems. The approach described here, however, gives the DLTS spectrum between 77 degrees and 300 degrees K.