Effect of tuftsin on in vivo development of 3-methylcholanthrene-induced primary fibrosarcoma and Lewis lung carcinoma in mice.

The effect of tuftsin therapy on tumor development was examined in a murine primary fibrosarcoma and the Lewis lung carcinoma systems. Following im injection of 3-methylcholanthrene (CAS: 56-49-5) on day 0, C57BL/10ScSn mice were treated weekly with 3 ip tuftsin injections beginning on day 1 or day 60. Similar patterns of tumor development were observed regardless of whether tuftsin therapy was immediate or delayed. Only modest differences in experimental and control tumor incidences were found upon termination of studies; however, treated animals developed significantly fewer tumors than controls early during the observation periods. Thus mean tumor latent periods varied significantly when therapy began on day 1 (103.6 days in controls vs. 119.1 in treated mice; P = .02) or 2 months later (104.6 days in controls vs. 115.3 in treated mice; P = .01). One day subsequent to intra-footpad implantation of 10(5) Lewis lung carcinoma cells, C57BL/6 mice received at least 10 iv injections of tuftsin and were compared with controls for variations in survival or lung tumor development. The mean survival time in treated mice, 41.2 days, differed sharply from that (30.1 days) in controls (P = .00001). Similar groups of mice varied significantly in mean metastatic lung colony counts when examined on day 30; there were 15.1 colonies in controls and 8.0 in experimental animals (P = .03).

Disordered eating, body mass, and glycemic control in adolescents with type 1 diabetes.

OBJECTIVE: To examine the relationship between disordered eating attitudes and behaviors, BMI, and glycemic control in adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS: In a cross-sectional design, 152 adolescents (ages 11-19 years) completed three scales from the Eating Disorders Inventory (EDI): Body Dissatisfaction, Drive for Thinness, and Bulimia. All subjects had diabetes for > 1 year. Glycemic control was assessed by glycosylated hemoglobin (HbA1c). Height and weight were measured to assess BMI. RESULTS: Adolescents with type 1 diabetes did not report more disordered eating attitudes and behaviors than the normative comparison sample. Male subjects with type 1 diabetes reported fewer symptoms of bulimia and female subjects with type 1 diabetes reported greater body satisfaction than the normative group. A higher BMI was a significant predictor of greater body dissatisfaction, more so for female than male subjects. Symptoms of bulimia were associated with older adolescence and female sex. Those with more symptoms of bulimia were also more likely to have a higher BMI. Sex (female) and body dissatisfaction (more dissatisfied) predicted a stronger desire to be thin. Longer duration of disease, more symptoms of bulimia, and obesity all predicted poorer glycemic control. CONCLUSIONS: Female patients aged 13-14 years seem to be at greatest risk for developing disordered eating patterns. Using the clinical cutoff score (> or = 5) of the EDI Bulimia subscale as a screener in diabetes clinics may help identify adolescents whose disordered eating patterns are likely to compromise their glycemic control.

Effects of meclofenamate and captopril on adrenal blood flow: contrasts in conscious rabbits at rest and after hemorrhage.

The role of prostaglandins and angiotensin II or kinins in maintaining adrenal blood flow was studied using the prostaglandin cyclo-oxygenase inhibitor meclofenamate and the kininase inhibitor captopril in resting and hemorrhaged (10 ml/kg) conscious rabbits. Meclofenamate (6 mg/kg intravenously) reduced adrenal blood flow after 3, 15 and 30 minutes by 26, 28 and 17 percent, respectively. Captopril increased adrenal flow by 20 percent, an effect subsequently reversed by meclofenamate. In contrast, hemorrhaged rabbits maintained adrenal blood flow following meclofenamate and captopril despite substantial reductions in renal blood flow with meclofenamate given before and after captopril. It is concluded that (1) adrenal blood flow at rest is modulated by vasodilator prostaglandins and to a lesser extent angiotensin II or bradykinin. (2) The adrenal effects of meclofenamate and captopril are overriden by hemorrhage, perhaps reflecting the need to increase adrenal hormones during hypovolemic stress. (3) The decrease in plasma catecholamines seen with meclofenamate at rest may be due to reduced adrenal blood flow.

Evolution of IgA nephropathy into Henoch-Schoenlein purpura in an adult.

IgA nephropathy (IgAN) and Henoch-Schoenlein purpura (HSP) are clinically distinct conditions indistinguishable on renal biopsy. However, progression from IgAN to HSP has rarely been reported, particularly in adults. We report such a case: a young man with biopsy-proven IgAN and no systemic features of HSP who six years later developed classical HSP. This supports suggestions that the two conditions are different manifestations of the same disease.

A prospective study of central venous hemodialysis catheter colonization and peripheral bacteremia.

BACKGROUND: Sepsis as a consequence of central venous hemodialysis catheter colonization is a major cause of morbidity in the hemodialysis population. We have previously shown that the majority of catheters become colonized and that this is associated with peripheral bacteremia. The time period over which this colonization occurs is unknown. METHOD: A prospective study of 31 central venous hemodialysis catheters was performed. Central venous blood cultures were taken from the catheter weekly after insertion. When the central cultures became positive, indicating catheter colonization, peripheral venous blood cultures were taken during dialysis to detect peripheral bacteremia. RESULTS: Twenty-one catheters (68%) became colonized before their removal for reasons other than infection (mean time to colonization 27 days, range 5-115 days). Eleven patients (35%) developed peripheral bacteremia with the same organisms (mean time from colonization to bacteremia 32 days, range 5-26 days). Bacteremia only occurred when blood drawn from the catheter cultured more than 3000 colony forming units per ml. CONCLUSIONS: Bacterial colonization of central venous catheters often leads to bacteremia. The time between insertion and colonization is very variable, but is universally present after 16 weeks. The risk of subsequent bacteremia is related not only to time left in situ, but also the degree of colonization. Surveillance cultures would allow clinicians to detect colonization before bacteremia occurs and take preventative measures.

Renal biopsy in the elderly: clinicopathological correlations in 143 patients.

The clinical presentation and spectrum of renal histopathology is described in 143 patients aged 60 years or more, with renal disease. In 82 patients renal biopsy revealed primary renal disease. In the remainder, changes associated with systemic conditions were found. These included amyloidosis, polyarteritis nodosa and hypertension. Fifty patients present with the nephrotic syndrome, one third of whom had a membranous glomerulonephritis on the renal biopsy. Three patients had a carcinoma associated with this renal histology. Two patients had a minimal change lesion and their nephrotic syndrome responded to corticosteroids. Renal biopsies from the 45 patients present with renal failure revealed a variety of histopathology which included idiopathic crescentic nephritis and antiglomerular basement membrane disease. Percutaneous renal biopsy is a valuable diagnostic aid in elderly patients with renal disease.

Central airways obstruction in carcinoma of the bronchus treated by radiotherapy: a study of pulmonary function.

A battery of lung function tests was performed on 28 patients with carcinoma of the bronchus, before radiotherapy, six weeks later, and at three months. Twenty-five had evidence of ariways obstruction, though only five had a forced expiratory ratio of less than 50%. Nine were shown to have obstruction to a main or lobar bronchus, while 11 definitely did not, but the only significant difference in lung function between groups was in the residual volume calculated from single breath helium dilution. Eight of ten cases of squamous cell carcinoma were central, and seven of these obstructive. Of seven cases with undifferentiated cells only two were central (p less than 0.05) and one obstructive. Breathlessness on presentation was significantly more common in patients with central tumours (6/12) than those with peripheral lesions (1/8), and all six breathless patients with central tumours claimed that this symptom improved after radiotherapy. Radiotherapy may have a palliative effect for breathlessness in patients with central airways obstruction due to tumour.

Haemodialysis patients' knowledge and beliefs about medication.

Patient adherence to treatment continues to concern health professionals. Non-adherence is costly to: a) the patient in terms of health, psychological well-being and quality of life, b) the health care providers in terms of individual professionalism, job satisfaction and the provision of optimum care packages, and c) the managers in terms of finance and service planning. Several factors are thought to be influential in treatment adherence.

[Moderate supplementation of potassium in essential hypertension]. / L'apport d'un complément modéré de potassium dans l'hypertension essentielle.

23 unselected patients with mild to moderate essential hypertension, whose average supine blood pressure after two months' observation on no treatment was 154/99 mm Hg, were entered into an eight week double blind randomised crossover study of one month's treatment with slow release potassium tablets (60 mmol/day) versus placebo without alteration of dietary sodium or potassium intake. By the fourth week mean supine blood pressure had fallen by 4% on potassium supplementation compared with placebo. Urinary potassium excretion increased from 62 +/- 4.7 mmol/24 h on placebo to 118 +/- 7.4 mmol/24 h on potassium. The fall in blood pressure was not related to urinary sodium excretion before entry to the trial or while on placebo. Moderate potassium supplementation caused a small but significant fall in blood pressure in patients with mild to moderate essential hypertension and could be additive to the effects of moderate sodium restriction. This increase in potassium intake could be achieved with a potassium-based salt substitute and a moderate increase in vegetable and fruit consumption. Moderate dietary sodium restriction with dietary potassium supplementation may obviate or reduce the need for drug treatment in some patients with mild to moderate hypertension.

Continuous ambulatory peritoneal dialysis in systemic amyloidosis and end-stage renal disease.

Three patients with end-stage renal failure complicating systemic amyloidosis have been treated with continuous ambulatory peritoneal dialysis for periods of 10, 14 and 18 months respectively. In each case satisfactory control of uraemia and fluid balance has been achieved.

Recording patients' views on organ donation: when to ask them and how to record the answer.

KIE: Six hundred twenty-six adult outpatients in two British general hospitals completed questionnaires on organ donation. The patients were asked their opinions on being asked their views on donating their organs after death, on when during an outpatient or a hospital visit they would prefer to be asked about donations, and on how they would choose to have their decision recorded. Commenting on their findings, the authors recommend that a question on organ donation be included on the registration form for new hospital outpatients, and that patients' responses be recorded on the hospital computer.^ieng

Restoration of acutely thrombosed arterio-venous fistulae by rTPA and percutaneous angioplasty.

Acute thrombosis in native arterio-venous fistulae (AVF) results in considerable patient morbidity. Interventional radiology (IR) comprising thrombolysis and percutaneous transluminal angioplasty (PTA) is well established in the management of thrombosed polytetrafluoroethylene (PTFE) grafts. However its role in thrombosed AVF is uncertain. We looked retrospectively at the role of IR in re-establishing blood flow in acutely throm-bosed AVF. Between 1992-2000, 21 episodes of acutely thrombosed AVF in 15 patients (9 females; age range 29-80yrs) were referred for intervention. All fistulae were being used for haemodialysis at the time. Diagnosis was established by angiography and thrombolysis with recombinant tissue plasminogen activator (rTPA) was attempted in all patients. Discrete stenoses when present (n=12) were then treated with PTA and resistant or recurrent stenoses were managed by stent insertion (n=3). Patients were then heparinised for 24 hours. Technical success as defined by radiological patency was achieved in 86% cases. Clinical success i.e. the ability to reuse of the fistula for haemodialysis was achieved in 62% of the interventions, where patency rates at 3 and 6 months were 92% and 69% respectively. Five patients had recurrence of thrombosis >3 months after the primary procedure, 3 had successful reintervention. Minor local bleeding was the only complication. Our retrospective study shows rTPA and PTA is successful in the management of acutely thrombosed AVF. We advocate the routine use of IR as a valuable technique for prolonging the life of native AVF in patients on maintenance haemodialysis.

Home monitoring of blood pressure. Comparison of once daily morning measurements with those made throughout the day.

Six subjects were investigated to establish whether self-recorded morning blood pressure is a reliable indicator of that taken throughout the day. After instruction, subjects recorded resting blood pressure on 6 successive mornings, and then hourly throughout the day. The morning pressures in each patient on each of the 6 days were very closely related to one another, with an overall mean of 157/102 mmHg (n = 36). Overall blood pressures throughout the day were not significantly different from the morning ones (158/100 mmHg, n = 88). Standard deviation for morning systolic blood pressure in each patient ranged from 4.5-8.4 compared with 3.8-10.4 mmHg for systolic blood pressure throughout the day. For diastolic blood pressure the ranges of standard deviation were 2.3-8.4 and 2.6-6.5 mmHg, respectively. No patient demonstrated a circadian rhythm. It seems that self-monitoring of blood pressure is reproducible and that the time of day that the measurement is made is unimportant, provided the patient is resting.

Maintenance dialysis in a district general hospital.

A programme of Continuous Ambulatory Peritoneal Dialysis has been in progress at the Gloucester Royal Hospital since January 1988. After 2 years patient and technique survival was 81% and 73% respectively, very similar to that in established British Renal Units. Management of end stage renal failure at the local District General Hospital has meant that patients no longer have to travel long distances to the Regional Renal Unit.