Evaluation of Uric Acid to Albumin Ratio as a Marker of Coronary Artery Disease Severity in Acute Coronary Syndrome: A Cross-Sectional Study.

BACKGROUND: Coronary artery disease (CAD) is a widespread cause of morbidity and mortality. Serum uric acid, a mediator of endothelial dysfunction and inflammation in vascular disease, can increase the risk of atherosclerosis, contributing to CAD. As serum albumin inhibits platelet activation and aggregation, low levels of it can contribute to platelet-induced coronary artery stenosis. Limited studies have been conducted worldwide in evaluating the role of uric acid to albumin ratio (UAR) in predicting severity or poor outcomes in acute coronary syndrome (ACS) patients. This study was undertaken to assess the role of UAR as a predictor of CAD severity, which can facilitate the identification of high-risk patients. METHODOLOGY: A hospital-based analytical cross-sectional study was conducted in an urban tertiary healthcare center for a period of two months between June and August of 2022. A total of 100 ACS patients were included in the study. The study population included patients above the age of 18 years diagnosed with ACS who underwent a coronary angiography. Coronary angiograms were used to diagnose the presence of CAD, and its severity was assessed using Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) scores (SS). The correlation of UAR with CAD severity using SS was studied and compared between three varieties of ACS: ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA). STATISTICS: Chi-squared tests were used to determine statistical significance for qualitative data. Independent t-tests were used to identify the mean difference between two quantitative variables. Receiver operating characteristic (ROC) curves were constructed for UAR and high SS. A comparison between UAR and neutrophil to lymphocyte ratio (NLR) as a predictor of disease severity was done. ROC and optimal cutoff points were chosen to calculate sensitivity, specificity, and positive and negative predictive values. Microsoft Excel (Microsoft, Redmond, WA, USA) and SPSS V22.0 (IBM Corp., Armonk, NY, USA) were used to analyze the data. RESULTS: A total of 100 ACS patients were included in the study and divided into two groups on the basis of SS, with 74% showing low severity and 26% showing intermediate-high severity. There was a statistically significant difference found between older age and SS (p=0.017). Our study showed 74% (n=74) of the patients were male and 26% (n=26) were female. It also revealed that 75.7% (n=56) of the male patients were in the low-severity group, and 24.3% (n=18) of males were in the intermediate-high severity group. 69.2% (n=18) of the female patients were in the low-severity group, and 30.8% (n=8) were in the intermediate-high severity group. Of the 100 patients, 55% were diagnosed with STEMI, of which 69.1% were in the low-severity group, and 30.9% were in the intermediate-high severity group. Among all the patients 33% of the patients were diagnosed as NSTEMI, of which 72.7% were in the low-severity group, and 27.3% were in the intermediate-high severity group. Twelve percent of the patients were diagnosed with UA, and 100% of these patients were in the low-severity group. The mean UAR was 1.40 ± 0.38 in the low-severity group and 1.29 ± 0.46 in the intermediate-high severity group (p=0.22). CONCLUSION: Our study yielded no statistically significant difference in UAR among varying severities of CAD.

Consequential study on different levels of C/N ratios used in biofloc-based aquaculture system / Estudo consequente sobre diferentes níveis de proporções C/N utilizadas no sistema de aquicultura à base de biofloc

Biofloc technology is much highlighted these days because of its tremendous effects on aquaculture. Microbes were enriched on cheapest organic carbon source i. e., powdered banana peels and were incorporated in different aquaria rearing grass carp fingerlings under different C/N treatments (10:1, 15:1 and 20:1) and 10% water daily water exchange. The initial growth of fingerlings was recorded. The experiment was settled in triplicates for 60 days and run parallel to control group provided with commercial feed and daily water exchange. Its effect was evaluated by measuring the growth of fingerlings and water parameters of each aquarium. The average % gain in weight and length of fingerlings was obtained significantly highest (28.12 ± 0.30g and 17.29 ± 0.46cm respectively) in aquaria containing pure powdered banana peels with 10% water exchange and C/N ratio was adjusted at 20: 1 (T3) than other treatments and control. Ammonia and other water parameters were also under control in T3 than other experimental and control groups. By all counts, it was concluded that the highest C/N ratio in biofloc system had the potential to increment C. idella growth rate by reducing toxicity and could be used as fish meal substitute.

A tecnologia Biofloc é muito destacada hoje em dia por causa de seus tremendos efeitos na aquicultura. Os micróbios foram enriquecidos com a fonte de carbono orgânico mais barata, i. e., cascas de banana em pó, e foram incorporadas em diferentes aquários de criação de alevinos de carpa-capim sob diferentes tratamentos C/N (10: 1, 15: 1 e 20: 1) e 10% de troca diária de água. O crescimento inicial dos alevinos foi registrado. O experimento foi resolvido em triplicatas por 60 dias e executado paralelamente ao grupo controle fornecido com ração comercial e troca diária de água. Seu efeito foi avaliado medindo o crescimento dos alevinos e os parâmetros da água de cada aquário. O% de ganho médio em peso e comprimento dos alevinos foi obtido significativamente mais alto (28,12 ± 0,30g e 17,29 ± 0,46 cm respectivamente) em aquários contendo cascas de banana em pó puro com 10% de troca de água e a relação C/N foi ajustada em 20: 1 (T3) do que outros tratamentos e controle. A amônia e outros parâmetros da água também estavam sob controle no T3 mais do que nos outros grupos experimentais e de controle. Por todas as contagens, concluiu-se que a maior razão C/N no sistema de bioflocos tem o potencial de incrementar a taxa de crescimento de C. idella reduzindo a toxicidade e pode ser usada como substituto da farinha de peixe.

Consequential study on different levels of C/N ratios used in biofloc-based aquaculture system

Abstract Biofloc technology is much highlighted these days because of its tremendous effects on aquaculture. Microbes were enriched on cheapest organic carbon source i. e., powdered banana peels and were incorporated in different aquaria rearing grass carp fingerlings under different C/N treatments (10:1, 15:1 and 20:1) and 10% water daily water exchange. The initial growth of fingerlings was recorded. The experiment was settled in triplicates for 60 days and run parallel to control group provided with commercial feed and daily water exchange. Its effect was evaluated by measuring the growth of fingerlings and water parameters of each aquarium. The average % gain in weight and length of fingerlings was obtained significantly highest (28.12 ± 0.30g and 17.29 ± 0.46cm respectively) in aquaria containing pure powdered banana peels with 10% water exchange and C/N ratio was adjusted at 20: 1 (T3) than other treatments and control. Ammonia and other water parameters were also under control in T3 than other experimental and control groups. By all counts, it was concluded that the highest C/N ratio in biofloc system had the potential to increment C. idella growth rate by reducing toxicity and could be used as fish meal substitute.

Resumo A tecnologia Biofloc é muito destacada hoje em dia por causa de seus tremendos efeitos na aquicultura. Os micróbios foram enriquecidos com a fonte de carbono orgânico mais barata, i. e., cascas de banana em pó, e foram incorporadas em diferentes aquários de criação de alevinos de carpa-capim sob diferentes tratamentos C/N (10: 1, 15: 1 e 20: 1) e 10% de troca diária de água. O crescimento inicial dos alevinos foi registrado. O experimento foi resolvido em triplicatas por 60 dias e executado paralelamente ao grupo controle fornecido com ração comercial e troca diária de água. Seu efeito foi avaliado medindo o crescimento dos alevinos e os parâmetros da água de cada aquário. O% de ganho médio em peso e comprimento dos alevinos foi obtido significativamente mais alto (28,12 ± 0,30g e 17,29 ± 0,46 cm respectivamente) em aquários contendo cascas de banana em pó puro com 10% de troca de água e a relação C/N foi ajustada em 20: 1 (T3) do que outros tratamentos e controle. A amônia e outros parâmetros da água também estavam sob controle no T3 mais do que nos outros grupos experimentais e de controle. Por todas as contagens, concluiu-se que a maior razão C/N no sistema de bioflocos tem o potencial de incrementar a taxa de crescimento de C. idella reduzindo a toxicidade e pode ser usada como substituto da farinha de peixe.

Seroprevalence of Toxoplasma gondii and associated hematological alterations in small ruminants of D.G. Khan district of Southern Punjab, Pakistan / [Soroprevalência de Toxoplasma gondii e alterações hematológicas associadas em pequenos ruminantes no distrito de D.G. Khan no sul de Punjab, Paquistão]

The present study was carried out to evaluate the prevalence and hematological effects of Toxoplasma gondii in sheep and goat in district Dera Ghazi Khan. Blood samples (n=204) were collected comprise goats (n=101) and sheep (n=103) alongwith age, gender and breeds of animals. Samples were collected randomly from 25 flocks of 7 different union council Viz. Vehova, Tibbi Qaisrani, Lakhani, Kohar, Tuman Qaisrani, Nutkani and Kot Qaisrani of Tehsil Taunsa Sharif at least 4 animals from each flock. All ruminants divide into three groups based on age, breed and gender. The prevalence was detected through two different kits Viz. LAT and ELISA kit. The overall prevalence suspected in goats through LAT and ELISA kit was (35.64%), (32.67%) and in sheep was (25.24%), (23.30%) respectively. The Toxoplasma gondii had a significant effect on goats in age groups and non-significant all other groups of goats and sheep. Toxoplasma gondii had a significant effect on all hematological parameters like Hemoglobin, total leukocyte cells, granulocytes, lymphocytes, platelets, and red blood cells, except monocytes. In conclusion of the current study, toxoplasmosis is prevalent among ruminants, reveals the possibility of transmission to humans on the use of host animals as protein source.(AU)

O objetivo do presente estudo foi avaliar a prevalência e efeitos hematológicos de Toxoplasma gondii em ovelhas e cabras no distrito Dera Ghazi Khan. Amostras de sangue (n=204) foram coletadas para incluir cabras (n=101) e ovelhas (n=103), além de idade, gênero e raça dos animais. Amostras foram coletadas aleatoriamente de 25 rebanhos de 7 conselhos sindicais: Vehova, Tibbi Qaisrani, Lakhani, Kohar, Tuman Qaisrani, Nutkani e Kot Qaisrani of Tehsil Taunsa Sharif com pelo menos 4 animais em cada rebanho. Todos os ruminantes foram divididos em três grupos baseados em idade, raça e gênero. A prevalência foi detectada usando dois kits, LAT e ELISA. A prevalência total suspeita em cabras através dos kits LAT e ELISA foi (35.64%), (32.67%) e em ovelhas foi (25.24%), (23.30%) respectivamente. O Toxoplasma gondii teve efeito significativo em cabras em grupos de idade e não significativo em todos os outros grupos de cabras e ovelhas. Toxoplasma gondii teve efeito significativo em todos os parâmetros hematológicos como hemoglobina, células totais de leucócitos, granulócitos, linfócitos, plaquetas e glóbulos vermelhos, exceto monócitos. O presente estudo conclui que toxoplasmose é prevalente entre ruminantes, e revela a possibilidade de transmissão para humanos com o uso de animais hospedeiros como fonte de proteína.(AU)

What Burden of Prostate Cancer Can Radiologists Rule Out on Multiparametric Magnetic Resonance Imaging? A Sensitivity Analysis Based on Varying the Target Condition in Template Prostate Mapping Biopsies.

OBJECTIVE: To evaluate the minimum disease burden of prostate cancer at which multiparametric magnetic resonance imaging (MRI) optimally performs. METHODS: Between 2006 and 2008, 64 men underwent multiparametric MRI imaging (index test) followed by template prostate mapping biopsy (reference test). Three radiologists independently reported each quadrant of every prostate on a scale of 1 to 5: highly likely benign, likely benign, equivocal, likely malignant, highly likely malignant (≥3 or ≥4 was considered positive). There were 256 prostate sectors; bootstrapping adjustment was used to account for nonindependence. The target condition indicating cancer on biopsies was varied by changing the maximum cancer core length (MCCL) and total cancer core length (TCCL) within each sector from 1 mm to 10 mm. The sensitivity, specificity, and positive (PPVs) and negative predictive values (PPVs) were calculated for each MCCL and TCCL. Gleason ≤3+3 and Gleason ≥3+4 cancers were analyzed separately. RESULTS: Mean age was 62 years (range, 40-76 years), and mean prostate-specific antigen level was 8.2 µg/L (range, 2.1-43 µg/L). Fifty percent of quadrants (127 of 256) had prostate cancer, of which 65% (83 of 127) were Gleason ≤3+3. For Gleason ≤3+3, multiparametric MRI had an NPV of ≥95% at an MCCL of ≥5 mm and at a TCCL of ≥7 mm (MRI score ≥3). For Gleason ≥3+4, an NPV of ≥95% was seen at an MCCL of ≥5 mm (MRI score ≥3) and TCCL ≥6 mm. CONCLUSION: Multiparametric MRI may allow areas of the prostate which test negative to avoid biopsy. Whether multiparametric MRI can be used as a "triage" test before the first biopsy requires results from ongoing prospective validating cohort studies.

A case of synchronous malignancy of stomach and kidney.

The synchronous occurrence of primary renal cell carcinoma with gastric cancer is very rare. We report a case of 41 year old male who presented on 05/07/2011 to M S Ramaiah hospital, Bangalore with history of fever, pain abdomen and malena. Ultrasound abdomen and pelvis showed large heterogenous mass arising from the upper pole of left kidney. Computed tomography of the abdomen showed left renal cell carcinoma. Renal biopsy showed features consistent with renal cell carcinoma - clear cell type. Oesophagogastroduodenoscopy revealed gastric polypoidal growth. Gastric biopsy from the growth revealed poorly differentiated adenocarcinoma of stomach. We report this case to highlight a rare occurrence of synchronous malignancy of stomach and kidney.

The management of lung cancer: a UK survey of oncologists.

AIMS: This report reviews current radiotherapy practice across the UK in the management of lung cancer, and the way new treatments and technologies are being introduced, where improvements have occurred, and where work is still required. We wanted to determine adherence to both National Radiotherapy Advisory Group and National Institute for Health and Clinical Excellence (NICE) guidance. This survey was conducted on behalf of the Department of Health Lung Cancer & Mesothelioma Advisory Group. MATERIALS AND METHODS: We sent a questionnaire to all UK radiotherapy departments. It covered radical radiotherapy dose fractionation, the use of concurrent or sequential chemotherapy for both non-small cell and small cell lung cancers, the use of continuous hyperfractionated accelerated radiotherapy, new radiotherapy techniques, the use of positron emission tomography/computed tomography for planning purposes and patient accrual into current National Cancer Research Network UK trials. RESULTS: This UK-wide survey of radiotherapy practice for lung cancer showed broad compliance with NICE clinical guidance, but highlighted significant variation in fractionation schedules and the use of concomitant chemoradiotherapy. Clinical trial entry into lung cancer radiotherapy trials was variable and many centres are not fully participating in recruitment into these trials. CONCLUSIONS: This report has shown the variability of radiotherapy provision nationally. Current practice is largely consistent with current and updated NICE recommendations and best practice and should be recognised as such. It has also highlighted areas where improvements are still needed, particularly fractionation and new technologies. One particular aspect of concern is the poor recruitment to current UK-based clinical trials in lung cancer.

Magnetic resonance imaging for the detection, localisation, and characterisation of prostate cancer: recommendations from a European consensus meeting.

BACKGROUND: Multiparametric magnetic resonance imaging (mpMRI) may have a role in detecting clinically significant prostate cancer in men with raised serum prostate-specific antigen levels. Variations in technique and the interpretation of images have contributed to inconsistency in its reported performance characteristics. OBJECTIVE: Our aim was to make recommendations on a standardised method for the conduct, interpretation, and reporting of prostate mpMRI for prostate cancer detection and localisation. DESIGN, SETTING, AND PARTICIPANTS: A consensus meeting of 16 European prostate cancer experts was held that followed the UCLA-RAND Appropriateness Method and facilitated by an independent chair. MEASUREMENT: Before the meeting, 520 items were scored for "appropriateness" by panel members, discussed face to face, and rescored. RESULTS AND LIMITATIONS: Agreement was reached in 67% of 260 items related to imaging sequence parameters. T2-weighted, dynamic contrast-enhanced, and diffusion-weighted MRI were the key sequences incorporated into the minimum requirements. Consensus was also reached on 54% of 260 items related to image interpretation and reporting, including features of malignancy on individual sequences. A 5-point scale was agreed on for communicating the probability of malignancy, with a minimum of 16 prostatic regions of interest, to include a pictorial representation of suspicious foci. Limitations relate to consensus methodology. Dominant personalities are known to affect the opinions of the group and were countered by a neutral chairperson. CONCLUSIONS: Consensus was reached on a number of areas related to the conduct, interpretation, and reporting of mpMRI for the detection, localisation, and characterisation of prostate cancer. Before optimal dissemination of this technology, these outcomes will require formal validation in prospective trials.

The diagnostic utility of the flare phenomenon on bone scintigraphy in staging prostate cancer.

PURPOSE: Bone scintigraphy (BS) lacks sensitivity for detecting very early skeletal metastases (SM) in prostate cancer (PC) and is often limited by poor specificity. Also scintigraphic flare of SM can occur following effective treatment and mislead an early response assessment. We hypothesised that a flare reaction might amplify the signal from subclinical SM, increasing the sensitivity of BS and that the phenomenon may be specific for metastases. METHODS: We conducted a prospective study to determine the frequency of the flare phenomenon in patients with metastatic PC starting hormone therapy and to explore its utility in patients with negative staging scans but considered at high risk of SM and in those with equivocal baseline BS abnormalities. Ninety-nine patients commencing first-line hormone therapy had repeat BS at 6 weeks to score a flare reaction. RESULTS: Of 22 patients with unequivocal SM on the baseline scan, a flare occurred in 9 (41%). Of 36 high-risk localised prostate cancer patients with normal BS pre-treatment, the scan became positive for metastases at 6 weeks in 4 (11%). Of 41 patients with pre-treatment scintigraphic abnormalities of uncertain aetiology, a flare occurred in 8 cases (20%). All eight were confirmed to have SM by follow-up and imaging. Of the 33 remaining patients without a flare, 2 developed SM at 14 months and the remainder did not develop SM in a median follow-up period of 36 months. CONCLUSION: The flare phenomenon following initial hormone therapy can be used to improve both sensitivity and specificity of BS in PC.

Patient consultation survey in an ophthalmic outpatient department.

INTRODUCTION: Consultation methods differ between medical practitioners depending on the individual setting. However, the central tenet to the doctor-patient relationship is the issue of confidentiality. This prospective survey highlights patient attitudes towards consultation methods in the setting of an ophthalmic outpatient department. METHOD: Questionnaires were completed by 100 consecutive patients, who had been seen by an ophthalmologist in a single room, which had a joint doctor-patient consultation occurring simultaneously. RESULTS: Each question of all 100 questionnaires was completed. 58% of patients were not concerned about sharing a consultation room with another patient or doctor. However, this did not equate to the 49% of patients who were indifferent to discussing issues in the joint consultation room. The most common factor was the general issue of confidentiality. DISCUSSION: Ensuring total patient confidentiality may be deemed more necessary for certain medical specialties than for others, as seen in the practice of separate medical records in genitourinary medicine, for instance. However, with regard to patient consultations, the same level of confidentiality should be afforded across all specialties, and such factors should be borne in mind when planning outpatient clinics.

Cataract surgery for junior ophthalmologists: are there enough cases?

AIM: To evaluate those cases that are suitable for operation by the junior ophthalmic trainee. METHODS: A prospective survey of 96 consecutive cases from five consultant lists for phacoemulsification over a 1 month period were preoperatively assessed for their suitability for the ophthalmic trainee using set criteria. A checklist was designed for all patients and criteria were marked with reference to suitability by a single examiner. The criteria chosen were arbitrary and had no bearing on a consultant's final decision to allow the junior to operate. RESULTS: Twenty-two out of 96 cases (22.9%) were deemed to be suitable for operation by a junior ophthalmologist (ie 4.4 cases per consultant list). The three main reasons for exclusion were first eye case, eye for operation with visual acuity 6/12 or better, and mature cataract. DISCUSSION: Using our results, if 4.4 cases were suitable for a junior ophthalmologist per month, this would allow for adequate exposure during the early stages of training. However, if the number of relatively straightforward cases on training lists were to be reduced owing to unavailability on hospital waiting lists, this could potentially compromise ophthalmic training in the future.

Effect of hyaluronidase on ocular motility and eyelid function in sub-Tenon's anaesthesia: randomised controlled trial.

PURPOSE: To assess the effect of hyaluronidase on eye and eyelid movements when used as an adjunct in sub-Tenon's anaesthesia. METHODS: A total of 60 patients who had sub-Tenon's anaesthesia prior to phacoemulsification surgery were divided into two equal groups in a double-masked randomised controlled fashion. Of these, Group A had 4 ml lignocaine 2%, while Group B had 4 ml lignocaine 2% with the addition of sodium hyaluronidase 75 IU/ml. Ocular motility, levator, and orbicularis oculi function were measured in all patients at 5 and 8 min. Levator function was scored from 0 (no function) to 3 (complete function) while orbicularis function was scored from 0 to 2. The score for ocular motility was the sum in four positions of gaze, each position scoring from 0 to 2. Results were compared using a nonparametric test. RESULTS: Group B achieved significantly better ocular and lid akinesia than Group A both at 5 and 8 min with P<0.01. The median scores for levator function at 5 and 8 min were 2 for Group A and 0 for Group B. For orbicularis function, the median scores at both time intervals were 2 for Group A and 1 for Group B. For ocular motility, the median score for Group A at 5 min was 3 and at 8 min was 2.5; for Group B at 5 min was 0.5 and at 8 min was 0. CONCLUSIONS: The addition of hyaluronidase in sub-Tenon's anaesthesia has a significant effect in improving ocular and lid (levator and orbicularis) akinesia.

Retrospective analysis of abdominal surgeries at Nepalgunj Medical College (NGMC), Nepalgunj, Nepal: 2 year's experience.

BACKGROUND: Abdominal surgeries are the commonest major operations that are performed in the department of surgery. AIM: To find out the different causes of emergency and elective abdominal surgeries at Nepalgunj Medical College Teaching Hospital (NGMCTH) Nepalgunj, Nepal. MATERIAL AND METHOD: This is a retrospective study conducted in the department of surgery at NGMCTH Nepalgunj, Nepal, over a period of 2 years (2001 to 2003). The patients included in this study were drawn from Banke, Bardiya, Kailali, Kanchanpur, Surkhet, Dang, Dailake, and Tikapur. They belong to both sexes and different age groups. All the records of these patients under went laparotomy for elective as well as emergency conditions were included in this study. The data were analyzed; tabulated and following results were obtained. RESULTS: The commonest cause of emergency laparotomies were peritonitis (peptic ulcer, enteric and appendicular perforations) whereas, the commonest cause of elective laparotomies were chronic cholecystitis with cholelithiasis followed by chronic appendicitis and pyloric obstruction. CONCLUSION: Over all, cholecystectomy for cholecystitis with cholelithiasis was the commonest operation, which was done in last two years. This disease may be because of excessive use of saturated animal fat and vegetable oil. Peritonitis was the 2nd commonest cause of abdominal surgery. Among the causes of peritonitis, peptic ulcer perforations were the frequent followed by enteric and appendicular perforations. Appendicitis was the 3rd commonest cause of abdominal surgery. Nepal, being a Hindu country, people consume excessive amount of meat, and possibly due to this, the disease of the appendix was very high as compared to other Asian countries where people live on bulk cellulose diet.

Fleur-de-Lys abdominoplasty--a consecutive case series.

Sixty-eight consecutive patients who had undergone Fleur-de-Lys abdominoplasty are described. The mean age was 39 years, (22-62 years) and the mean body mass index (BMI) was 29 kg/m(2) (17-47 kg/m(2)). Forty patients had documented weight loss, mean 39 kg (10-103 kg). The operation duration ranged from 1 h 10 min to 4 h 15 min. The mean mass of tissue resected was 2.4 kg, (0.3-9.1 kg). The overall complication rate was 42/68 (62%) and complications were categorised as early, late, general and aesthetic. Complications were significantly related to patients with a greater age (p=0.0091), increasing BMI (p=0.0039), greater weight (p=0.0014) and greater mass of tissue resected (p=0.0002). There was no significant association between smoking and complications. There was no significant association between previous gastric partitioning surgery and complications. Despite the significant complication rate, a single operation achieved a satisfactory outcome in 82% of patients. Our data reinforce findings from previous studies, which have demonstrated that patients should be required to reduce weight prior to body contouring surgery.

Anti-inflammatory agent, dexamethasone, does not affect exercise-induced arterial hypoxemia in Thoroughbreds.

In view of the suggestion that pulmonary injury-induced release of histamine and/or other chemical mediators from airway inflammatory and mast cells contribute to the exercise-induced arterial hypoxemia (EIAH) in human athletes, we examined the effects of pretreatment with a potent anti-inflammatory agent, dexamethasone, on EIAH and desaturation of hemoglobin in horses. Seven healthy, sound, exercise-trained Thoroughbreds were studied in the control (no medications) experiments, followed in 7 days by intravenous dexamethasone (0.11 mg.kg(-1).day(-1) for 3 consecutive days) studies. Blood-gas measurements were made at rest and during incremental exercise leading to maximal exertion at 14 m/s on a 3.5% uphill grade. Galloping at this workload induced pulmonary hemorrhage in all horses in both treatments, thereby indicating that stress failure of pulmonary capillaries had occurred. In both treatments, significant EIAH, desaturation of hemoglobin, hypercapnia, acidosis, and hyperthermia developed during maximal exercise, but significant differences between the control and dexamethasone treatments were not discerned. The failure of pretreatment with dexamethasone to significantly affect EIAH suggests that pulmonary injury-evoked airway inflammatory response may not play a major role in EIAH in racehorses. However, our observations in both treatments that EIAH developed quickly (being evident at 30 s of exertion) and that its severity remained unaffected by increasing exercise duration (to 120 s) suggest that EIAH has a functional basis, probably related to significant shortening of the transit time for blood in the pulmonary capillaries as cardiac output increases dramatically.

Use of recombinant human thyrotropin in a complicated case of metastatic papillary thyroid carcinoma.

OBJECTIVE: To describe a complicated case of metastatic papillary thyroid carcinoma and the use of recombinant human thyrotropin (thyroid-stimulating hormone) (rhTSH) in conjunction with treatment with radioactive iodine (131I). METHODS: We present a detailed case report and discuss the use of rhTSH in this setting. RESULTS: A 62-year-old Filipino man with a history of incompletely treated papillary thyroid cancer sought medical assistance in the emergency department because of weakness of the right upper extremity. Imaging studies showed a large mediastinal mass in association with C7 vertebral body erosion and spinal cord impingement. A cervical lymph node biopsy revealed papillary thyroid carcinoma, follicular variant. Further imaging studies disclosed widely metastatic disease. The patient subsequently had a complicated treatment course and received rhTSH in conjunction with 131I treatment. CONCLUSION: This unusual case demonstrates possible complications of metastatic papillary thyroid carcinoma along with innovations in treatment options, including the use of rhTSH to stimulate the uptake of radioiodine by thyroid cancer cells.