Lactational performance of first-parity transgenic gilts expressing bovine alpha-lactalbumin in their milk.

The goal of this study was to determine whether the presence of the bovine alpha-lactalbumin transgene in first-lactation gilts enhances lactational performance and litter growth. Transgenic and sibling nontransgenic gilts were bred to nontransgenic boars. Litters were standardized to 10 piglets within 24 h of farrowing. Milk production was measured by the weigh-suckle-weigh method on d 3, 6, 9, and 12 of lactation. Bovine alpha-lactalbumin was present in the colostrum and milk of transgenic gilts throughout lactation. The expression of the transgene was associated with alterations in composition of mammary secretions, especially in early lactation. Lactose concentrations were greater (P < 0.05) in mammary secretions of transgenic gilts during the first 12 h postpartum compared with controls. In contrast, total solids concentration in mammary secretions from transgenic gilts were lower (P < 0.05) relative to controls during the first 6 h postpartum. Transgenic gilts produced more milk than controls on d 3, 6, and 9 of lactation (P < 0.01). By d 12, differences in milk production between transgenic and control sows were no longer different. Lactose intake by transgenic-reared litters was greater than lactose intake by control-reared litters on d 6 of lactation (P < 0.05). Total solids intake was significantly greater (P < 0.05) by transgenic-reared litters on d 3 and 6 compared to control-reared litters. The day x genotype interaction on litter weight gain after birth was highly significant (P = 0.011), with transgenic-reared litters gaining weight at a greater rate than control-reared piglets. Expression of the transgene was associated with increased milk production in lactating gilts and increased growth of transgenic-reared piglets. Increased lactose synthesis in response to the presence of the transgene may result in increased milk production in early lactation, leading to increased milk component intake by transgenic litters, and ultimately to increased growth of litters reared by first-parity transgenic gilts.

Hemolytic-uremic syndrome in adolescents.

OBJECTIVE: To compare the epidemiological characteristics, clinical features, and outcome of adolescents with hemolytic-uremic syndrome (HUS) with those of children with HUS. DESIGN: A retrospective descriptive study using data stored in the computerized Utah HUS registry. SETTING: The HUS registry contains data on postdiarrheal and nondiarrheal HUS cases since 1970 in which the patients were younger than 18 years of age at the time of diagnosis and includes virtually all Utah cases as well as those referred from surrounding states. PATIENTS: Seventeen adolescents (age, 12-17 years) and 276 younger patients from September 30, 1970, through December 5, 1993, who met the diagnostic criteria for HUS. MAIN OUTCOME MEASURES: Age, sex, seasonality, prodromal features (eg, antecedent diarrhea), laboratory values, hospital course, outcome, and chronic sequelae. RESULTS: The 17 adolescent patients, who composed 5.8% of the study population, experienced a course of the disease that was similar to that of the younger patients. Diarrhea preceded HUS in approximately 90% of the patients in both groups. Laboratory values were similar in teenagers and younger patients. The hospital courses were also similar; seizures occurred in almost 20%, and hypertension and oligoanuric renal failure occurred in most. Two (12%) of the teenagers and 7 (2.4%) of the younger patients died during the acute phase of the syndrome (P = .09); almost 50% of both groups experienced 1 or more chronic renal sequelae. End-stage renal disease has occurred in 1 (5.8%) of the teenagers and 6 (2.2%) of the children. At follow-up, 1 or more years (median, 5 years) after the onset of HUS, hypertension was present in 22% of the teenagers and 6.7% of the preteens (P = .14). A below-normal glomerular filtration rate was seen in approximately 30% of both groups; proteinuria was noted in approximately 25% of both groups. Approximately 10% of both groups had a combination of proteinuria and a low glomerular filtration rate and are, therefore, at risk for eventual end-stage renal disease. CONCLUSIONS: In our region of the Intermountain West, HUS in adolescents closely resembles that seen in children and the outcome is more favorable than that experienced by adults.

Atypical hemolytic-uremic syndrome: a comparison with postdiarrheal disease.

OBJECTIVES: To compare the epidemiologic, laboratory, clinical, and outcome variables of atypical (nondiarrheal) hemolytic-uremic syndrome with those of classic postdiarrheal disease. METHODS: A 24-year retrospective review of 28 episodes of atypical HUS that occurred in 22 children compared with 266 episodes of typical postdiarrheal disease in 265 children treated during the same period. RESULTS: Of the 294 episodes of HUS, 9.5% were atypical (nondiarrheal), and 18% of the patients in the atypical disease group had recurrences. Prodromal features (other than the presence or absence of diarrhea) were similar between the groups. White blood cell count and serum creatinine concentration on admission to the hospital and most abnormal blood urea nitrogen values during hospitalization were significantly lower (p = 0.02) in the patients with atypical HUS. Oliguria, anuria, and the need for dialysis were also less common (p = 0.02) in the atypical disease group. There were no deaths in the subset of patients with atypical disease; 3.4% of the patients in the typical disease group died. Although there were no statistically significant differences in the incidence of end-stage renal disease between the atypical and typical disease groups, two of the four patients with atypical disease who had recurrences also had end-stage renal disease. There were no significant differences in chronic renal sequelae between the groups one or more years after HUS. CONCLUSIONS: In contrast to reports from most other regions, patients with atypical disease in our area of the western United States have milder acute nephropathy and, with the exception of those with recurrence, do not experience worse outcomes.

Managing patients with benign prostatic hyperplasia.

Benign prostatic hyperplasia is the usual cause of prostatism--irritative and obstructive urinary symptoms. Steps in making the diagnosis include a focused neurologic examination, urinalysis, serum creatinine determination and, possibly, catheterization to detect urinary retention. It is difficult to predict the likelihood of future complications, such as complete urinary obstruction, even for patients with severe symptoms. The natural course of prostatism is a waxing and waning of symptoms. Treatment options are watchful waiting, medication, transurethral prostatectomy, and newer surgical treatments such as microwave thermopathy and laser ablation. The family physician can counsel patients about the potential side effects of these treatments as well as the problems incurred by simply adjusting to the disabilities associated with benign prostatic hyperplasia.

Do drugs affect social behavior in the confused elderly?

Mental confusion in the elderly can be manifested by impairments in the areas of memory, orientation, concentration, and judgment. The number and classification of drugs prescribed for elderly residents of nursing care facilities can contribute to the development of mental confusion. As the number of drugs prescribed for confused elderly increases, the potential for these persons to engage in group social behavior decreases.

Acute spinal epidural abscess.

A case of acute spinal epidural abscess is reported demonstrating many of the important features in the natural history of the disorder. The pathological changes in the cord at the level of the lesion are described. A series of 12 patients is reviewed. The average interval between the initial consultation and the onset of complete paralysis is 5 days and it is essential that the diagnosis is made during this period. Two indicators of prognosis are discussed--the duration of complete paralysis and the extent of sensory disturbance.

Factors influencing readmission to hospital: II. Paraplegia.

This study of 200 paraplegics shows that occupational status at the time of becoming paralysed exerts as great an influence upon readmission to hospital as does the level or the extent of the lesion and that the effect of the level of the lesion on readmission to hospital increases with lower occupational status.

An ergonomic appraisal of the use and functional efficiency of condom urinals in the male patient with spinal cord paralysis.

The variety and method of use of condom urinals was reviewed and an investigation conducted to ascertain the problems which arise. Effects arising from material failure and methods of use were disclosed.

Factors influencing readmission to hospital. I. Tetraplegia.

Tetraplegia produces exceptionally severe physical impairment causing disability which demands almost total dependence on others for the activities of daily living but there is no impairment of mental function. The tetraplegic is, therefore, capable of influencing his environment and those features of it which may lead to the need for readmission to hospital. Of the factors studied relating to readmission to hospital, only age and occupational status of the patient at the time of his paralysis are of significance.

Percutaneous cystostomy in paraplegia--a follow-up of 41 patients.

Percutaneous cystostomy using a fine calibre (9 Charriere) plastic trocar and cannula has been used in 51 male patients in the early weeks following spinal cord injury. The results are satisfactory. Of the last ten patients none has been catheterised per urethram; eight of these patients are now passing urine satisfactorily using a condom urinal.

Percutaneous suprapubic cystostomy after spinal cord injury.

The results of treatment of urinary bladder paralysis with small calibre (9 Charriere) suprapubic drainage in 41 male patients are described. It was found that suprapubic drainage could be maintained for an average of 8 weeks and that the urine in 43% of patients remained sterile for an average of 7 weeks. This technique merits further trial, both in the paraplegic patient and in normal patients requiring catheterisation because of obstruction of the lower urinary tract.