Glucocorticoid and mineralocorticoid stimulation of atrial natriuretic peptide release in man.

To investigate the influence of a mineralocorticoid and a glucocorticoid on plasma immunoreactive atrial natriuretic peptide (irANP) and possible functional correlates, eight normal men received in random order 9 alpha-fludrocortisone acetate (9 alpha F; 0.6 mg/day), prednisone (50 mg/day), and placebo each for 9 days. Their diet contained 130 mmol sodium and 75 mmol potassium daily. The mean supine plasma irANP levels were similar on days 2, 4, and 9 of placebo treatment [25 +/- 10 (+/- SE), 27 +/- 5, and 27 +/- 6 pmol/L, respectively]. Mean plasma irANP levels were 76 +/- 42 (P less than 0.05), 89 +/- 34, and 93 +/- 29 pmol/L (P less than 0.01), respectively, on days 2, 4, and 9 during 9 alpha F administration, and 68 +/- 37 (P less than 0.05), 83 +/- 41, and 48 +/- 18 pmol/L on the same days during prednisone administration. Compared with the placebo period, sodium intake minus urinary output during 9 alpha F administration averaged +41 mmol at the time of blood sampling on day 2, +112 mmol on day 4, and +149 mmol on day 9; body weight was unchanged on day 2 and increased by 0.7 and 1.1 kg on days 4 and 9, respectively. Escape from 9 alpha F-induced renal sodium retention occurred on days 5 and 6. During prednisone administration, sodium intake minus urinary output and body weight did not change. Plasma volume and BP rose significantly during 9 alpha F (P less than 0.05) but not during prednisone administration. Plasma renin, aldosterone, and norepinephrine (NE) decreased during 9 alpha F treatment (P less than 0.05 to less than 0.01); during prednisone treatment, plasma aldosterone levels were lower on day 9 only. Cardiovascular pressor responsiveness to angiotensin II was enhanced during 9 alpha F but not prednisone administration, while blood pressure reactivity to NE was not significantly modified. These findings demonstrate that 9 alpha F and prednisone in high doses provoke remarkably similar increases in plasma irANP, but that the glucocorticoid-induced rise in plasma irANP is due to a mechanism other than sodium and volume retention.

Exposure to pulsed high-frequency electromagnetic field during waking affects human sleep EEG.

The aim of the study was to investigate whether the electromagnetic field (EMF) emitted by digital radiotelephone handsets affects brain physiology. Healthy, young male subjects were exposed for 30 min to EMF (900 MHz; spatial peak specific absorption rate 1 W/kg) during the waking period preceding sleep. Compared with the control condition with sham exposure, spectral power of the EEG in non-rapid eye movement sleep was increased. The maximum rise occurred in the 9.75-11.25 Hz and 12.5-13.25 Hz band during the initial part of sleep. These changes correspond to those obtained in a previous study where EMF was intermittently applied during sleep. Unilateral exposure induced no hemispheric asymmetry of EEG power. The present results demonstrate that exposure during waking modifies the EEG during subsequent sleep. Thus the changes of brain function induced by pulsed high-frequency EMF outlast the exposure period.

A suprasternal approach to the mediastinum using real-time ultrasonography. Echoanatomical correlations.

This work was undertaken in order to define the potential capabilities of real-time echography for the exploration of the mediastinum by a suprasternal approach. We present the results of a comparative study between anatomical frontal oblique sections of the mediastinum and echographic slices performed along the same planes from the suprasternal fossa. From these data, it seems possible to enlarge the applications of echography in the study of mediastinal pathology.

[Ultrasonically-guided diagnostic punctures in pancreatic and adrenal diseases]. / Ponctions diagnostiques échoguidées en pathologie pancréatique et surrénalienne.

This study is based on the results of 38 punctures of adrenal and 62 punctures of pancreatic lesions measuring 1.5 to 12 cm (mean size: 4 cm in the pancreas; 6.5 cm in the adrenal glands). We used a free-hand technique with a mechanical sector probe. In the pancreas, the sensitivity of cytology is 67%, the specificity 100%. This low sensitivity is due to the difficulty in obtaining an adequate specimen when the tumor is predominantly fibrous. In the adrenal glands, the sensitivity is 90% and the specificity 100%. The results of our study are comparable to other series of guided punctures with US or CT reported in the literature. Microbiopsies with cutting needles can increase the sensitivity of the method in case of pancreatic tumors.

[Contribution of echography to the diagnosis of cancer of the exocrine pancreas. Pitfalls and limits. Results of guided biopsy]. / Apport de l'échographie au diagnostic du cancer du pancréas exocrine. Pièges et limites. Résultats de la biopsie guidée.

The importance of ultrasound in the diagnosis of primary pancreatic adenocarcinoma is due to the wide use of ultrasound as a first diagnostic modality in the case of abdominal problems, immediately after the physical examination. The results of the ultrasound examination allow the physician to choose the best way to explore the pancreas further (CT, pancreatography, angiography, MRI). The technical quality of the ultrasound examination is mandatory and the radiologist must be able to recognize its insufficiencies. The pancreatic adenocarcinoma is difficult to see with ultrasound: infiltration, ill-defined borders and echopattern; the lymph node or metastatic involvement is frequent and remains a good diagnostic sign. Many pitfalls can be attributed to this technique; the variations of the normal anatomy, the diversity and variable appearance of pancreatic lesions and the association with pancreatitis. The US-guided puncture represents a way to limit the use of diagnostic exploratory laparotomy.

[Role of ultrasonography and ultrasound-guided puncture in the diagnosis of hepatocellular carcinoma]. / Rôle de l'échographie et de la ponction échoguidée dans le diagnostic du carcinome hépato-cellulaire.

This retrospective study was undertaken to assess the place and efficacy of ultrasonography, and ultrasound-guided biopsy in the diagnosis of hepatocellular carcinoma in a series of 34 patients. The sonographic signs were not specific, as tumor patterns were very different from one case to another; there were no pathognomonic signs of hepatocellular carcinoma in comparison with hepatic metastases. Tissue characterization of the liver abnormalities was obtained by percutaneous ultrasound-guided biopsies. In our experience, ultrasonography has a double role: demonstration of hepatic nodules, particularly in high risk patients (cirrhosis); histologic identification of the nodules by ultrasound-guided biopsy.

[Basic sonographic interpretation]. / Sémiologie élémentaire ultrasonore.

Basic sonographic semiology includes the dots and lines that are the basic constituants of ultrasound images and the different structures that are the sonographic representation of the different tissues (fluid, fat, calcifications and stones, air, parenchyma). Knowledge of these basic interpretative skills is mandatory to the clinical practice of sonography and allows understanding of the different sonographic manifestations of pathologic processes and identification of artifacts and pitfalls.

[Suprarenal cysts. Diagnostic value of percutaneous puncture guided by echoscopy (author's transl)]. / Kyste surrénalien. Apport diagnostique de la ponction percutanée guidée par échoscopie.

Percutaneous needle aspiration was carried out in one case of suprarenal cysts which had already been evaluated by pyelography, echography and angiography. The characteristics of the aspirated liquid pointed towards a benign lesion, and enabled conservative treatment to be initiated. More generally, diagnosis of suprarenal tumors benefits from the direct approach already applied to other abdominal tumors.

[Percutaneous puncture under sectorial real time ultrasonography control]. / Technique de ponction percutanée guidée par échographe temps réel sectoriel.

A technique for percutaneous puncture is described which employs sectorial scanning real time ultrasonography without a mechanical system for needle control. The method has given satisfactory results in 200 punctures, including one case in which a liver metastasis 13 mm in diameter was detected and another case with a wirsung's duct of 4 mm diameter.

[Control of massive hematuria after nephropyelotomy by selective intra-arterial injections of noradrenaline (author's transl)]. / Contrôle d'une hématurie massive aprés néphropyélotomie par injection intra-artérielle sélective de noradrénaline.

Severe hematuria after pyelonephrotomy was controlled by the selective injection of noradrenaline into the renal artery. The indications for this conservative therapeutic technique are defined as well as its place in relation to hemostatic surgical procedures.

[Ultrasonographic guidance of percutaneous biopsies and punctures]. / Guidage échoscopique des ponctions et biopsies transcutanées.

Real time ultrasonography is routinely used for guidance of percutaneous punctures towards small targets, with three goals: 1. Aspiration biopsies for analysis of an abnormality detected with ultrasonography. 2. Injection of contrast media inside normal structures (urinary, biliary or pancreatic tract) or abnormal collection (cysts, pseudocysts). 3. Treatment by percutaneous sclerosis, aspiration, decompression, drainage.

[Arteriovenous fistula of the spleen revealed by ascites and profuse diarrhea. A case report including ultrasonography and arteriography findings (author's transl)]. / Ascite et diarrhées profuses révélatrices d'une fistule artério-veineuse splénique. Evaluation échographique et artériographique.

Abdominal pain, ascites and diarrhea revealed acute portal hypertension in a young woman. Ultrasonography and angiography demonstrated the causative congenital arterio-venous fistula of the splenic vessels. Surgery was successfully performed.

[Sonographic imaging of lymphatic vessels compared to other methods]. / Apport de l'échographie à l'imagerie des vaisseaux lymphatiques par rapport aux autres méthodes.

This paper reviews for the first time the normal and abnormal appearances of lymphatic channels of the skin using ultrasound. After a review of anatomy and histology, the authors present the current imaging modalities available for lymph vessel imaging. The ultrasound examination is presented with a description of the author's technique as well as the technical requirements of the ultrasound unit (12 MHz linear probe with a resolution of 400 microns). They present the ultrasound appearance of normal lymphatic channels and their relationships to the dermis, hypodermis and lymph nodes, and at last the ultrasound appearance of abnormal lymphatic pathways

[Transcutaneous wirsungography under echoscopic control]. / Wirsungographie transcutanée sous contrôle échoscopique.

Two cases of contrast radiography of Wirsung's canal performed by direct percutaneous puncture of the canal under ultrasonic control are reported. The exploration was well tolerated by the patients. This method appears to be of considerable interest in liver and pancreas diseases, being reliable and providing valuable information.

[Diffuse superficial nephroblastomatosis. Chemotherapy. 1 case]. / Néphroblastomatose diffuse superficielle. Traitement par chimiothérapie. 1 observation.

A case of superficial diffuse nephroblastomatosis involving both kidneys in a 14-months old child is reported. Urographic and arteriographic results as well as the still little-known ultrasonographic images made it possible to determine pre-operatively the nature of the tumour and to exclude the initial diagnosis of Wilm's tumour. A relatively non-aggressive chemotherapy resulted in complete involution of the subcapsular tumoral envelope. The close embryogenic and oncogenic relationship between nephroblastoma and nephroblastomatosis is recalled.

Work and family. Competing demands affecting worker well being.

1. As employed women juggle the responsibilities of employment and family caregiving, many experience stress and fatigue from the competing demands on their time and energy. 2. Evidence suggests that perceptions are changing about the institutional relationships between families, government, and the economy, and the value society places on caregiving activities. 3. The pending Family and Medical Leave Act represents one of the broadest social remedies proposed to address the problems of the work-family interface. But, in the absence of federal and state policies, employers can fill the void with private policies and programs that meet employees' needs. 4. A variety of options exist to create a more "family friendly" work environment. Occupational health nurses can play an important role in supporting and implementing family friendly initiatives at the workplace.