March myoglobinemia: a hazard to renal function.

Serum muscle enzyme levels, myoglobin levels, and renal function were measured in a group of 20 army recruits who had volunteered for a prolonged period of primary, specially designed, gradual training. Blood samples were taken before training and before and after each hike. Levels of serum myoglobin, creatinine phosphokinase, lactic dehydrogenase, and SGOT indicated muscle injury. Levels of urea creatinine, and uric acid and creatinine clearance evaluated renal function. Substantial elevation of muscle enzyme levels and persistent myoglobinemia were observed throughout the study. A highly significant decrease in creatinine clearance was demonstrated. After the last hike, the mean creatinine clearance was 70.41 mL/min, which is notably lower than the value at the beginning of the study. Prolonged physical exercise induces muscular damage, as evidenced by a rise in myoglobin and enzyme levels. Continuous muscle injury induces persistent myoglobinemia, a probable hazard to renal function.

Splenogonadal fusion diagnosed by spleen scintigraphy.

Splenogonadal fusion (SGF) is a rare congenital malformation characterized by fusion of the spleen and a gonad (almost always the left one) frequently associated with orofacial and/or limb developmental abnormalities. Only 125 cases were reported between 1883 and 1994. This report concerns a case of SGF in a 20-yr-old woman with an accidental finding of a splenic space-occupying lesion protruding into the lower abdomen in ultrasound and CT. Radiocolloid spleen scintigraphy and SPECT proved to be the best procedure to establish the correct diagnosis of SGF. As SGF is often asymptomatic, more liberal use of splenic scintigraphy is suggested in patients with congenital limb and/or orofacial anomalies. SGF should be included among the differential diagnoses of left abdominal, pelvic or scrotal masses.

Extralobar sequestration presenting as massive hemothorax.

Pulmonary extralobar sequestration is a rare anomaly, usually diagnosed during the first months of life. A case of extralobar pulmonary sequestration in an adult, manifesting itself as massive hemothorax, is presented.

The use of radioiodinated toluidine blue for preoperative localization of parathyroid pathology.

The efficiency of preoperative radioactive toluidine blue (RTB) scintigraphy for the localization of parathyroid pathology was evaluated prospectively in 69 patients (age range, 15 to 81 years; mean, 56 years) with primary hyperparathyroidism. Four patients have previously undergone negative exploratory surgery. Patients underwent preoperative dual radionuclide parathyroid-RTB/technetium 99m (Tc 99m)-thyroid scintigraphies with a computer-interfaced gamma-camera with a pinhole collimator. Computer-acquired scintigraphic data were analyzed for parathyroid localizations by an RTB-parathyroid/thyroid superposition technique. At surgery, parathyroid adenomas were found in 64 patients (single adenomas in 60 patients; two adenomas in four patients), nine of these adenomas were mediastinal. Four patients had parathyroid hyperplasia. One patient had no parathyroid pathology (negative exploratory surgery). Correlation between the surgical-pathologic findings and the scintigraphic RTB localization studies disclosed a sensitivity of 87%, with a specificity of 94%, and an overall accuracy of 92%. The routine use of preoperative scintigraphic parathyroid-RTB/Tc 99m-thyroid localization has proved to be highly effective, enabling detection of small hyperfunctioning parathyroid glands in normal and ectopic locations in a wide range of weights. In this series a success rate of 98% was achieved on initial and reexploratory surgery for primary hyperparathyroidism.

Alterations in magnesium and zinc metabolism in thyroid disease.

Magnesium (Mg) and zinc (Zn) status was assessed in subjects to evaluate the effects of thyroid diseases on Mg and Zn metabolism. Plasma and red blood cell (RBC) concentration and peripheral blood mononuclear cell (MNC) content of Mg and Zn, and 24-hour urinary excretion of Mg, Zn, creatinine (Cr), calcium (Ca), sodium (Na), and potassium (K) were measured in 11 thyrotoxic, 29 hypothyroid, and 25 euthyroid control subjects. Serum albumin, alpha 2-macroglobulin, and the binding of Zn to albumin were also determined. Plasma and RBC Mg concentrations were low in half of the hyperthyroid subjects, but mean values were not significantly different from controls. Urinary excretion and clearance of Mg were lower in hypothyroid subjects, but differences were removed when expressed relative to Cr excretion and clearance. Similar patterns were noted for urinary Ca, Na, and K, suggesting that their reduced excretion reflects alterations in renal hemodynamics. Plasma Zn was lower in hypothyroid subjects and correlated with serum albumin; MNC Zn and urinary Zn were also low. Plasma Zn concentration was normal and serum albumin significantly lower in the hyperthyroid group than in the control group. Further, RBC Zn content was significantly lower in hyperthyroid subjects, and inversely related to plasma thyroxine concentration. The hyperthyroid group also excreted significantly greater amounts of Zn than controls, indicative of a catabolic process. This increased urinary loss may reflect a shift in the distribution of plasma Zn between ultrafilterable and Zn-albumin complexes. In summary, this study provides evidence for marked alterations in Zn homeostasis in persons with thyroid disease. Whether the observations indicate deficiency states and have clinical implications will require further investigation.

Zinc metabolism in patients treated with captopril versus enalapril.

Several zinc parameters were assessed in 13 patients with essential hypertension who were chronically taking only captopril (six subjects) or enalapril (seven subjects), as well as in six untreated hypertensives, and nine healthy controls. Serum zinc levels were comparable in all groups. Twenty-four-hour urinary zinc excretion was significantly increased in the captopril-treated patients compared with the other three groups. The zinc:creatinine ratio in 24-hour urine was significantly increased in both captopril and enalapril groups, but was significantly greater in the former. Although plasma zinc concentrations were comparable in all groups, red blood cell (RBC) zinc values were significantly decreased in the captopril group compared with the other three groups. We conclude that (1) although both captopril and enalapril produce renal zinc loss, this loss is far greater in patients receiving captopril; and (2) captopril administration over 3 months or more generates RBC zinc depletion.

Hypocalciuria of preeclampsia is independent of parathyroid hormone level.

Hypocalciuria is a feature of preeclampsia. The roles of parathyroid hormone (PTH) and vitamin D 1,25(OH)2D3 (calcitriol) in its pathogenesis have not yet been determined. Fourteen preeclamptic women were compared with 12 women with chronic hypertension and 11 normotensives, all in the third trimester. Preeclamptics had the lowest urinary calcium excretion rate (62.1 +/- 32.8 mg/24 hours) compared with chronic hypertensive women (162.6 +/- 97.8 mg/24 hours) and normotensive controls (225.6 = 146.9 mg/24 hours) (P less than .05). Serum PTH was lowest in preeclamptics (9.8 +/- 5.5 pg/mL), in contrast to the chronic hypertensives (18.5 +/- 2.7 pg/mL) and normotensives (16.4 +/- 3.2 pg/mL) (P less than .005). Similarly, urinary cyclic adenosine monophosphate (cAMP) excretion was 2.9 +/- 1.4 mumol/24 hours in the preeclamptics, 5.1 +/- 1.7 mumol/24 hours in the chronic hypertensives, and 4.6 +/- 1.3 mumol/24 hours in the normotensive group (P less than .05). These data suggest that the mechanism of hypocalciuria in preeclampsia is independent of the PTH-calcitriol axis. Therefore, it is suggested that the hypocalciuria of preeclampsia is due to intrinsic renal tubular dysfunction.

Magnesium homeostasis during high-intensity anaerobic exercise in men.

This study was conducted to determine whether short-term, high-intensity anaerobic exercise alters Mg homeostasis. Thirteen men performed intermittent bouts of treadmill running at 90% of their predetermined maximum O2 uptake until exhaustion on one occasion during a week in which all men were consuming a standard diet (115 mg Mg/1,000 kcal). Plasma and erythrocyte Mg concentrations and peripheral blood mononuclear cell Mg content were measured before and after the exercise. Complete 24-h urine collections were obtained on control days, on the day of exercise, and on the day after exercise. Exercise induced a transient but significant decrease in plasma Mg content (-6.8%; P less than 0.01); over 85% of the loss could be accounted for by a shift to the erythrocytes. Significant increases in urinary excretion of Mg were observed on the day of exercise (131.5 +/- 6.8 mg/day) compared with control days (108 +/- 6.6 mg/day), with the percent increase correlating with postexercise blood lactate concentration (r = 0.68; P less than 0.01) and oxygen consumption during recovery (r = 0.84; P less than 0.001). The data indicate that high-intensity anaerobic exercise induces intercompartmental Mg shifts in blood that return to preexercise values within 2 h and urinary losses on the day of exercise that return to base line the day after exercise. It is postulated that the exercise-induced increase in Mg excretion may depend on the intensity of the exercise, and the relative contribution of anaerobic metabolism to the total energy expended during exercise.

Frequent occurrence of renal calculi in tuberculous kidneys in Israel.

The incidence of renal calculi among renal tuberculous patients, hospitalized during thirty years in a medical center, was evaluated. It was found to be 24.5 per cent, most probably the highest figure so far reported in the medical literature.

Lipoprotein profile changes during intense training of Israeli military recruits.

The effect of prolonged strenuous military training on serum lipoproteins was studied in 73 new recruits. Dietary intake, body weight, and average energy expenditure were recorded, and blood samples collected at three time periods before training began (time 0), and after 6 and 12 wk of intense physical activity (times I and II, respectively). There was a significant increase in high density lipoprotein (HDL) cholesterol and a decrease in low density lipoprotein (LDL) cholesterol accompanying an increase of duration and intensity of exercise. HDL increased from 40.5 +/- 7.7 mg.dl-1 at time 0 to 44.5 +/- 9.4 mg.dl-1 at time I and to 52.8 +/- 8.7 mg.dl-1 at time II, and each mean P-value for increases in HDL from time 0-I, I-II, and 0-II were P < 0.0001). For LDL cholesterol, the mean decreases were -1.1, -6.1, and -7.3 mg.dl-1, respectively (P = 0.003 from I-II, and 0.01 from 0-II). These changes did not correlate with weight loss, reduced energy, or fat intake. We conclude that intense physical activity is associated with beneficial changes in the lipoprotein profile in new military recruits during a training period extending over 12 wk.

Parathyroid sonography: diagnostic accuracy related to shape, location, and texture of the gland.

The sonographic features of 51 pathological parathyroid glands detected pre-operatively were analysed. Atypical texture was found in 23.5% and variation in shape in 15.6% of the cases. Cystic parathyroid glands are difficult to differentiate from thyroid cysts, and may be the cause of false positive diagnosis, as in three cases in this series. Topographic assessment showed a relatively low sensitivity in detecting disease in the right upper gland (50%) and in the upper mediastinum (70%). The decreased accuracy in these regions is probably because of the particular anatomical location of the right upper gland and sonographic limitations in screening the mediastinal region. Awareness by the radiologist and surgeon of the variations in texture and location may influence both diagnosis and intraoperative detection of the abnormal parathyroid gland.

The challenge of endosseous implants placed in the posterior partially edentulous maxilla: a clinical report.

The survival rate of implants placed in the maxillary molar area in a 2-stage procedure was evaluated. Between 1990 and 1997, 60 consecutive patients (32 females and 28 males, mean age 51 years) received 87 implants to replace missing maxillary molar teeth. Radiographs were evaluated preoperatively for bone quantity (mesiodistal width, potential implant length not compromising the integrity of adjacent vital structures). Second-stage surgery was performed in a mean of 7.9 months postimplantation. The 5-year cumulative implant survival rate and the influence of implant characteristics (type, length, diameter, and coating) on implant failure and complication rates (between the 2 stages of surgery) were evaluated. The total 5-year cumulative survival rate was 95.4% (4 implants were lost). There were a total of 17 "complications" (premature spontaneous implant exposure) in non-failing implants, 11 with high and 6 with flat cover screws, respectively. Implantation in the edentulous maxillary molar area is a predictable procedure with a considerably high survival rate. The type of implant cover screw used can affect the complication rate.

"Is magnesium depletion the reason for ototoxicity caused by aminoglycosides?".

Aminoglycoside antibiotic drugs may cause ototoxicity and nephrotoxicity. Our hypothesis postulates that aminoglycosides cause ototoxicity by a mechanism of magnesium depletion in the hair cells of the cochlea. The same mechanism maybe responsible for nephrotoxicity caused by aminoglycosides.

Management control of aeromedical evacuation systems.

Aeromedical evacuation has been extensively used by military forces for evacuation of wartime casualties, but has also proven useful in civilian disaster response. In contrast to the broad coverage of the clinical aspects of the aeromedical evacuation, the operational and management control issues have rarely been addressed. The sophisticated battlefield of the 1980s has had an impact also in air evacuation, adding to the factors to be considered before launching an evacuation mission. The professional control of aeromedical evacuation is, therefore, crucial to the efficient and smooth operation of this high-cost resource. In an attempt to shed light on some of the operational perspectives of military air evacuation, the Israeli experience in the management control of such systems is discussed.

Increased amniotic fluid divalent cation concentration in preeclampsia.

Hypocalciuria due to reversibly enhanced tubular calcium reabsorption in preeclampsia has been previously described. As the fetus is exposed in utero to the toxemic environment, its kidney function may be similarly affected. We therefore evaluated the amniotic fluid (AF) concentrations of Ca2+, Mg2+, Zn2+, and Na+ in relation to creatinine in 12 preeclamptic women, 9 pregnant women with chronic hypertension, and 12 control pregnant women. Our data reveal an increased AF Ca2+, Mg2+, and Zn2+ to creatinine ratio in preeclampsia 451 +/- 283; 164 +/- 94; 787 +/- 124 Eq/mol, respectively) as compared with chronic hypertension (256 +/- 141; 94 +/- 46; 504 +/- 124 Eq/mol, respectively), and normal controls (274 +/- 132; 83 +/- 19; 477 +/- 124 Eq/mol, respectively; p < 0.05). Na+ concentration did not vary significantly among the three groups. It is suggested that the higher AF divalent cation concentration in preeclampsia may be due to lower maternal urinary excretion thereby increasing the fetal divalent cation load.

Using the PerioChip in treating adult periodontitis: an interim report.

Multicenter clinical trials have established that the adjunctive use of the subgingival controlled release of chlorhexidine, in the form of the PerioChip, significantly reduces pocket probing depth, improves probing attachment levels, and reduces bleeding on probing compared to scaling and root planing alone, for periods up to 9 months. The purpose of the present study was to report on the adjunctive use of the PerioChip for the long-term management of adult periodontitis for 2 years. A total of 836 patients with adult periodontitis from private dental offices were recruited into the trial. This interim report is on the first 72 patients to have completed the 2-year study. Treatments included initial definitive therapy followed by PerioChip placement in pocket sites with a pocket probing depth of > or = 5 mm after 1 month. Subsequently, the patients received routine periodontal maintenance therapy together with the placement of a PerioChip in pockets with pocket probing depths > or = 5 mm every 3 months. Results indicated that there was a continuous decrease in pocket probing depth over the 2 years (1.26 +/- 0.77 mm). This decrease in pocket probing depth was marked over the first 9 to 12 months, and then appeared to be less marked over the next 12 months. At 2 years, 60% of the patients had at least 2 pockets showing a reduction of 2 mm or more, and only 10% of the patients showed no change or increased pocket probing depth. The results indicate that adjunctive PerioChip use is a clinically effective treatment option for dental professionals and their patients for the long-term management of adult periodontitis.

[Inflammatory bowel disease and osteoporosis--an evidence-based connection].

Inflammatory bowel diseases (IBD) often have chronic or remittent course. Control of symptoms and disease activity often requires the administration of glucocorticoids. Osteoporosis is a frequent finding in patients with IBD. The evidence-based connection between the two conditions relies on a relatively limited number of cross-sectional and longitudinal studies. The cause of this connection has not been defined completely. Probably, both the chronic inflammation and the steroid therapy contribute to the osteopenia, through an increase in bone resorption without a compensatory increase in bone formation. There is little data regarding the efficacy of therapeutic interventions for the prevention of osteoporosis in patients with IBD. Recently, guidelines for the evaluation and treatment of osteoporosis and IBD have been published. There is need for further research on the relation between these conditions and on the efficacy of current therapy for this unique population.

[Osteoarticular tuberculosis in a general hospital].

The status of osteoarticular tuberculosis in recent years was studied. 82 cases diagnosed here between 1951-1985 were surveyed. The disease was more common among East European Jews (38%) and among young people: the mean age was 36 years and the highest incidence was in the third decade. A secular tendency to "aging" was noted, as in later years the mean age increased. However, there was also a secular decrease in incidence, explained by a progressive decrease in immigration to Israel. The disease affected most commonly the spinal vertebrae and the weight-bearing joints. There was an average delay of 19 months between onset of symptoms and/or signs of the disease and its diagnosis.

[Tuberculosis: a retrospective study].

In a retrospective study, 60 cases of tuberculosis (TB) were seen during 1968-1977. 95% were either Jewish or Bedouin. About 25% of the Bedouin were under 20 years of age. 62 of the cases had extra-pulmonary tuberculosis, while only 38% had the pulmonary form. As has been noted before, different ethnic groups had distinctive clinical features of tuberculosis. After a constant decline in the rate of tuberculosis in Israel for 4 decades, an increasing incidence has recently been observed. This trend is explained by waves of immigration from countries where tuberculosis is prevalent. The diagnosis was made quite late in the course of the disease, mainly because tuberculosis has been considered rare in Israel. A higher index of suspicion will allow earlier diagnosis and treatment of this curable disease.