Foraging, bioenergetic and predation constraints on diel vertical migration: field observations and modelling of reverse migration by young-of-the-year herring Clupea harengus.

Diel vertical migration (DVM) of young-of-the-year (YOY) herring Clupea harengus and one of their major predators, pikeperch Sander lucioperca, was examined using bottom-mounted hydroacoustics in Himmerfjärden, a brackish bay of the Baltic Sea, in summer. In contrast to previous studies on DVM of C. harengus aggregated across size and age classes, YOY C. harengus showed a reverse DVM trajectory, deeper at night and, on average, shallower during the day. This pattern was observed consistently on five acoustic sampling occasions in 3 years and was corroborated by two out of three trawl surveys. Large acoustic targets (target strength >-33 dB, probably piscivorous S. lucioperca >45 cm) showed a classic DVM trajectory, shallow at night and deeper during the day. Variability in YOY C. harengus vertical distribution peaked at dawn and dusk, and their vertical distribution at midday was distinctly bimodal. This reverse DVM pattern was consistent with bioenergetic model predictions for YOY C. harengus which have rapid gut evacuation rates and do not feed at night. Reverse DVM also resulted in low spatial overlap with predators.

Respiratory failure caused by tuberculous pneumonia requiring extracorporeal membrane oxygenation.

While a common pathogen, Mycobacterium tuberculosis (TB) pneumonitis is only rarely reported as a cause for respiratory failure in developed countries. We report an adolescent with TB pneumonitis and respiratory failure requiring extracorporeal membrane oxygenation (ECMO) with eventual survival. With the incidence of TB rising globally, TB should be suspected and treated as early as possible. ECMO should be considered as a treatment option if conventional ventilatory support is inadequate. ECMO survival with TB pneumonia and anti-TB antimicrobial therapy is possible.

Cyst fluid cytology and chemical features in a case of lymphoepithelial cyst of the pancreas: A rare and difficult preoperative diagnosis.

Most pancreatic cysts (90%) are inflammatory pseudocysts. Approximately 10% of pancreatic cysts are neoplasms, including serous cystadenomas, and mucinous tumors, some of which are malignant. Analysis of pancreatic cyst fluid obtained by percutaneous or endoscopic fine-needle aspiration is increasingly being used for the preoperative diagnosis of pancreatic or peripancreatic cysts. However, cyst fluid chemical and cytologic features in less common types of pancreatic cysts have not been reported. Lymphoepithelial cyst of the pancreas is exceedingly rare, and only occasional individual reports have described cyst fluid findings. We report on a case of lymphoepithelial cyst of the pancreas developing in a middle-aged man. Cyst fluid aspirated under radiological guidance showed elevated levels of carcinoembryonic antigen (CEA), CA19-9, CA 125, and amylase, and a viscosity greater than that of serum. A cell block preparation of a fine-needle aspiration showed tissue fragments with a keratinized squamous lining and a lymphocytic infiltrate in the wall, and abundant background keratinous debris. The cytologic and biochemical findings in this case exhibit similarities to the findings reported in other reports, and may represent a recognizable pattern on cyst fluid analysis.

Comprehensive modified diet simplifies nutrition management of adults with short-bowel syndrome.

Short-bowel syndrome (SBS) is a complex condition resulting from massive surgical resection of the intestinal tract. Nutrient malabsorption and metabolic alterations occur as a function of the portions of bowel removed and the length of remaining bowel segment. The nutrition management of SBS is challenging; many dietary restrictions are described, but inconsistently, throughout the literature. We compiled the restrictions and developed a comprehensive diet to reestablish adult patients with SBS on oral intake after surgery. Our purpose was to simplify the task of instructing patients with SBS in a diet that restricts all categories of food substances that may be poorly absorbed: fat, lactose, insoluble fiber, oxalates, and concentrated sweets. Suggestions to increase the transit time of ingested foods are included with the diet. Patients are taught the SBS diet after surgery and have bimonthly contact with the dietitian after leaving the hospital. Categories of restricted food substances, such as lactose, may be attempted and added back to the diet if they are tolerated. Bowel adaptation enhances tolerance to various dietary components over time. If sufficient bowel adaptation occurs, some patients are eventually able to return to an unrestricted diet.

A new method for the calibration of peak flow meters.

The objective of this paper is to assess the current methods for the calibration of peak flow meters and devise a method of producing a known flow with an inexpensive apparatus simple enough to be built from a set of dimensions. The methods currently available tend to be expensive and complex or impractical for routine use. The aim was that the wave form produced should approximate to a forced expiratory flow and be capable of being described in mathematical terms and be relatively inexpensive to produce. The resulting apparatus which has been built, produces a sine wave flow the peak of which can be set to any desired level and be determined to a high degree of accuracy. The apparatus can be built from a set of dimensions and is inexpensive. The apparatus is a primary and not a derived standard.

Neck pain as a presenting symptom in malignant hypertension.

Neck pain, unrelated to trauma, is relatively common and is usually presumed to be musculoskeletal in origin. A patient presented with an unusual and serious cause of neck pain-malignant hypertension. The mechanism of the neck pain may be incipient tonsillar herniation of the cerebellum caused by raised intracranial pressure.

Cerebral blood flow and carbon dioxide reactivity in neonates during venoarterial extracorporeal life support.

OBJECTIVES: a) To determine if cerebral blood flow is symmetric after internal carotid artery and ipsilateral internal jugular vein ligation in infants during venoarterial extracorporeal life support. b) To determine the cerebral CO2 reactivity (delta cerebral blood flow/delta torr CO2) of neonates during venoarterial extracorporeal life support and its correlation to neurodevelopmental outcome. DESIGN: Prospective, clinical study. SETTING: University hospital pediatric intensive care unit. PATIENTS: Fourteen neonates with respiratory failure who were receiving venoarterial extracorporeal life support. INTERVENTIONS: PaCO2 was altered by adjusting the CO2 gas flow through the membrane oxygenator. Cerebral blood flow was measured over both parietal-temporal regions at three PaCO2 values using xenon-133 clearance methodology. Cerebral blood flow measurements were made early (< or = 12 hrs of extracorporeal life support, n = 10) or late (> or = 48 hrs of extracorporeal life support, n = 10). In six of 14 infants, both early and late cerebral blood flow rates were measured. PaO2, mean arterial pressure, pump flow rate, and temperature were stable during each study period. Neurodevelopmental outcome was assessed in the neonatal follow-up clinic. MEASUREMENTS AND MAIN RESULTS: Right and left hemispheric cerebral blood flow rates were significantly correlated with each other during early and late extracorporeal life support (p = .0001; r2 = .91). Overall, hemispheric cerebral blood flow was statistically symmetric. There was no association of CO2 reactivity (delta cerebral blood flow/delta torr PCO2, range 0.04 to 1.36 mL/min/100 g/torr) with short-term neurodevelopmental outcome. Infants with normal neurodevelopmental outcome had variable CO2 reactivity (range 0.04 to 0.67 mL/min/100 g/torr). Normal short-term neurodevelopmental outcome was observed in two infants with cerebral blood flow of < 10 mL/min/100 g. CONCLUSIONS: Hemispheric cerebral blood flow was symmetric in infants during early and late venoarterial extracorporeal life support. Some subgroups showed a trend toward decreased right hemispheric cerebral blood flow, but the small number of patients limited interpretation of this finding. CO2 reactivity and cerebral blood flow were highly variable in this population, and were not predictive of short-term neurodevelopmental outcome. Stressed neonates with extremely low cerebral blood flow rates may have relatively normal short-term neurodevelopmental outcome after venoarterial extracorporeal life support.

Bactericidal antibiotics increase tumor necrosis factor-alpha and cardiac output in rats after cecal ligation and puncture.

We hypothesized that treatment of experimental sepsis with bactericidal antibiotics, known to enhance microbial toxin release, would alter tumor necrosis factor-alpha production and the hemodynamic response to the syndrome. In the rat, after cecal ligation and puncture (CLP), elevated serum TNF levels and cardiac output were observed following antibiotic treatment. TNF and cardiac output were elevated to a greater extent in bactericidal-treated than bacteriostatic-treated or antibiotic-untreated rats. Animals treated with bactericidal antibiotics also had significantly greater cardiac outputs than untreated rats. Despite increases in circulating TNF with antibiotic administration, the mortality rate at 96 hr decreased after either bactericidal or bacteriostatic antibiotics. We conclude that elevated TNF after CLP in rats treated with antibiotics is associated with enhanced hemodynamic responses to CLP, but does not increase early mortality. In this model of polymicrobial sepsis, bactericidal and bacteriostatic antibiotics led to different hemodynamic effects without compromising survival.

The U.S. EPA Geographic Information System for mapping environmental releases of Toxic Chemical Release Inventory (TRI) chemicals.

This study characterizes the environmental releases of toxic chemicals of the Toxic Chemical Release Inventory (TRI) in the southeastern United States by using the U.S. Environmental Protection Agency (EPA) Geographic Information System (GIS) to map them. These maps show that the largest quantities of TRI releases in the Southeast are usually near densely populated areas. This GIS mapping approach takes the first steps in defining those areas in the region which may be potential exposure zones and which could be strategic targets for future risk screening efforts in this geographic area.

Use of sentinel health events (occupational) in computer assisted occupational health surveillance.

The U.S. Coast Guard has developed a Coast Guard-wide comprehensive system for surveillance of workplace diseases. The American Medical Association's fifth edition of the Current Medical Information and Terminology (CMIT) was used as a reference to expand the basic list of 50 Sentinel Health Events (Occupational) [SHE(O)] published by the National Institute of Occupational Health and Safety (NIOSH), September, 1983. The expanded list of 107 sentinel events serves as a framework for the development of a computerized system of occupational health surveillance in the U.S. Coast Guard. This application of SHE(O) surveillance can have application in the early detection and prevention of environmental diseases.

Measurement of scoliosis by orthopedic surgeons and radiologists.

Minimum medical standards for USAF flying personnel have been compiled in Air Force Regulation 160-43. This regulation specifies the maximum allowable amount of scoliosis, but does not specify who should read the X-ray film to determine, using the Cobb method, the degree of curvature in scoliotic individuals. In the present study, an X-ray of an individual with mild scoliosis was sent to departments of radiology and orthopedics at major U.S. Armed Forces Medical Centers. Although the mean estimated degree of curvature was the same for both the orthopedists and the radiologists, the variance in the radiologists' replies was considerably higher than normally expected. It is, therefore, recommended that scoliosis films of individuals being screened for flying duties should be reviewed by a qualified orthopedic surgeon.

Aeromedical considerations of malaria prophylaxis with mefloquine hydrochloride.

Mefloquine hydrochloride (WR 142, 490) is a new investigational drug which is indicated for the prevention and treatment of cloroquine-resistant falciparum malaria thought to be resistant to other drugs. Available information on mefloquine, particularly its potential for "quinine-like" side effects, is of aeromedical importance. These side effects, if present, would be expected to alter performance and body physiology to a degree which would compromise flight safety. There is legitimate concern for mefloquine's safe use in aircrewmen. Mefloquine's potential for "quinine-like" side effects should be evaluated before it is routinely used for suppressive prophylaxis in aircrewmen.