Renal function in hypercalcemic dogs during hydropenia and during saline infusion

The effects of calcium-gluconate infusions on renal function were studied in unanesthetised dogs. Each dog was studied during hydropenia and saline infusion. Hypercalcemia, mean serum calcium 3.85 mmol/1 (hydropenia) and 3.62 mmol/1 (saline infusion), increased fractional excretion of sodium (C_Na/C_In), calcium (C_Ca/C_In), and magnesium (C_MgC_In). The increase was significantly higher in saline-expanded dogs than in hydropenic dogs. Fractional excretion of potassium (C_K/C_In) was increased in hydropenia but remained unchanged in saline-expanded animals. Fractional excretion of phosphate (C_P/C_In) was not consistently changed by hypercalcemia. Fractional excretion of chloride (C_Cl/C_In) was markedly increased in saline-expanded dogs but was not changed in hydropenia. Urine osmolality was reduced in hydropenic dogs but unchanged in saline-expanded dogs. In hydropenic as well as in saline-expanded dogs tubular reabsorption of solute-free water (T^c_H2O/C_In) increased during the first hour of hypercalcemia. In hydropenic dogs hypercalcemia caused a slight but significant decrease in blood pH, standard bicarbonate, and base excess. In hydropenic as well as in saline-expanded dogs glomerular filtration rate (C_In), renal plasma flow (C_PAH), and filtration fraction were unaffected.     

Role of Hypervolemia and Renin in the Blood Pressure Control of Patients with Pyelonephritic Renal Scarring

ABSTRACT Patients with pyelonephritic renal scarring are at risk of developing renal failure and hypertension. We studied glomerular filtration rate (GFR), renal plasma flow (RPF), filtration fraction (FF), systolic (SBP) and diastolic (DBP) blood pressure, fractional sodium, potassium and phosphate excretion, peripheral renin activity (PRA), plasma aldosterone (p-Aldo), urinary albumin excretion (U-Alb) and urinary β₂-microglobulin excretion (β₂-M) in hydropenia and during transition to 3% volume expansion with isotonic saline infusion in 22 female patients with renal scarring due to pyelonephritis and 9 healthy controls. The patients had significantly lower GFR, higher SBP and higher PRA in hydropenia, but there was no significant difference in RPF, FF, DBP or p-Aldo. After volume expansion, SBP, DBP, PRA and p-Aldo were significantly higher in patients than in controls. Transition to 3% volume expansion was associated with a similar increase in SBP in both patients and controls, whereas DBP increased significantly more in the patients (p<0.01). Volume expansion resulted in a significant suppression of PRA and p-Aldo in both patients and controls. The patients with renal scarring had the same capacity to excrete sodium and water during transition to volume expansion as the healthy controls. The renin-aldosterone system seems abnormally activated and is probably more important than hypervolemia in the development of hypertension in this group of patients.     

Early predictors of morbidity and mortality in trauma patients treated in the intensive care unit

Background: We investigated the incidence and severity of post‐injury morbidity and mortality in intensive care unit (ICU)‐treated trauma patients. We also identified risk factors in the early phase after injury that predicted the later development of complications. Methods: A prospective observational cohort study design was used. One hundred and sixty‐four adult patients admitted to the ICU for more than 24 h were included during a 21‐month period. The incidence and severity of morbidity such as multiple organ failure (MOF), acute lung injury (ALI), severe sepsis and 30‐day post‐injury mortality were calculated and risk factors were analyzed with uni‐ and multivariable logistic regression analysis. Results: The median age was 40 years, the injury severity score was 24, the new injury severity score was 29, the acute physiology and chronic health evaluation II score was 15, sequential organ failure assessment maximum was 7 and ICU length of stay was 3.1 days. The incidences of post‐injury MOF were 40.2%, ALI 25.6%, severe sepsis 31.1% and 30‐day mortality 10.4%. The independent risk factors differed to some extent between the outcome parameters. Age, severity of injury, significant head injury and massive transfusion were independent risk factors for several outcome parameters. Positive blood alcohol was only a predictor of MOF, whereas prolonged rescue time only predicted death. Unexpectedly, injury severity was not an independent risk factor for mortality. Conclusions: Although the incidence of morbidity was considerable, mortality was relatively low. Early post‐injury risk factors that predicted later development of complications differed between morbidity and mortality.     

Long-term effects of botulinum toxin A in children with cerebral palsy

The long-term effects of botulinum toxin A (BoNT-A) treatment in children with cerebral palsy (CP) are still elusive. We studied a prospective clinical cohort of 94 children with different subtypes (50% spastic diplegic CP, 22% hemiplegic CP, 25% tetraplegic CP, 3% dyskinetic CP), sex (55% male, 45% female), severity according to Gross Motor Function Classification System (29% Level I, 15% Level II, 16% Level III, 17% Level IV, 23% Level V), and age (median 5y 4mo, range 11mo–17y 8mo). The longest follow-up time was 3 years 7 months (median 1y 6mo) and included a maximum of eight injections per muscle (median two injections to a specific muscle). Outcome measurements were muscle tone (Modified Ashworth Scale) and joint range of motion (ROM). Assessments were made at a minimum before and 3 months after each injection. Ninety-five per cent confidence intervals for differences from baseline were used to identify significant changes. BoNT-A injections induced reduction of long-term spasticity in all muscle-groups examined: the gastrocnemius, hamstring, and adductor muscles. The reduction in tone was most distinct in the gastrocnemius muscle, and each repeated injection produced an immediate reduction in muscle tone. However, improvement in ROM was brief and measured only after the first injections, whereupon the ROM declined. Thus, the results suggest that BoNT-A can be effective in reducing muscle tone over a longer period, but not in preventing development of contractures in spastic muscles. The dissociation between the effects on muscle tone and ROM indicates that development of contractures is not coupled to increased muscle tone only, but might be caused by other mechanisms.     

Acute Symptoms During and Between Hemodialysis: The Relative Role of Speed, Duration, and Biocompatibility of Dialysis

Abstract: The relationship between hemodialysis (HD) symptoms and dialyzer membrane composition and area, blood–flow, treatment duration, urea removal, ultrafiltration volume, leukocyte activation, and complement generation (C3a) was studied in 20 patients undergoing 234 HD treatments by 12 different modes in random order using Cuprophan, hemophane, or polyamide membranes with small or large membrane areas with high Qb (400 ml/min) and short duration (2 h) or low Qb (200 ml/min) and long duration (4 h). Fewer symptoms occurred during the 2–h HD at high Qb than during the 4–h HD with low Qb (19% vs. 32%, p = 0. 0351). No differences were observed between different dialyzer membranes or areas. More intradialytic symptoms occurred when urea elimination was high than it was low (p = 0. 0044). Leukocyte activation (leukocyte drop) after 15 min of dialysis and complement generation did not influence symptom incidence. Blood pressure changes were mainly influenced by ultrafiltration volume (p < 0. 001). Symptoms between dialyses were determined by urea removal and ultrafiltration. Membrane, area, or Qb were of no importance. Thus, duration of dialysis, urea removal, and demand for ultrafiltration, but not membrane composition, area, or biocompatability, are important for the development of HD–related symptoms.     

Elastic outward bending of loaded buccal and lingual premolar walls in relation to cavity size and form

Abstract— The aim was to study effects of the size and form of the occlusal part of Class II cavities on elastic outward bending during loading of buccal and lingual walls, separated by the preparation. Twenty newly extracted caries-free premolars were used. A special arrangement for standardized cavity preparation was set up. In order to obtain accurate measurements of the outward bending of loaded cavity walls, an electronic tensile test device was constructed. Methodologic studies showed an insignificant departure from linearity between outward bending and load. All deformation was elastic. Correction factors were determined for strain of the apparatus as well as for indentation in the tooth substance. Measurement accuracy was calculated to ±0.12 N for force and ±0.2 μm for movement. In accordance with statistical principles, a few outlying measurements were discarded. The outward bending of buccal and lingual walls of cavities suitable for conservative restoration with dental amalgam was about 0.15 μm per Newton. Outward bending increased dramatically with exaggerated cavity depth and width. In the light of present knowledge of average chewing forces and tooth contacts in the habitual intercuspal position in young dentate adults, there seems to be little risk of leakage between conservative restorations and cavity walls as a result of elastic outward bending, though the risk certainly does increase with the depth and width of the cavity.     

Microalbuminuria in Long-term Insulin-dependent Diabetes Mellitus

ABSTRACT Albumin excretion rate was determined by radioimmunoassay in overnight urine from 102 normotensive patients with insulin-dependent diabetes mellitus of more than 10 years' duration. Based on two samples, 16 patients (16%) exhibited microalbuminuria, defined as a mean excretion rate >20 μg/min. Microalbuminuric patients were significantly younger at onset of diabetes but did not differ from normoalbuminuric patients concerning age or duration of diabetes. Nonetheless, diastolic and mean arterial blood pressures were significantly higher in the microalbuminuric group. The existing glycemic control, assessed by glycosylated hemoglobin (HbA_1C) was better in normoalbuminurics, but not significantly so. The albumin excretion rate in microalbuminuric patients correlated significantly (p<0.01) to diastolic (r=0.69) and to mean arterial blood pressure (r=0.69), but did not correlate to HbA_1C. Thus, it is concluded that even normotensive patients with signs of early diabetic nephropathy, i.e. microalbuminuria, exhibit small, but significant increases in blood pressure.     

Predictability in Diabetic Nephropathy

ABSTRACT Possible association between several variables and the prognosis of nephropathy was investigated in 23 insulin-dependent diabetics with established diabetic nephropathy. Age at onset and duration of diabetes, blood pressure and metabolic control were among these variables. In the mean observation period of 27 months, end-stage renal disease (ESRD) developed in 11 patients. Nine patients died, including six with progression to ESRD, mainly of cardiac disease. Age, duration of diabetes, insulin requirement, blood pressure and glycosylated hemoglobin concentration showed higher values in the patients with progression to ESRD, but no difference was statistically significant. During the observation time, however, blood pressure was less well controlled in the patients who developed ESRD. The deterioration rate of renal function showed wide interindividual variation. In each patient, however, the decline seemed to follow a linear regression course. The results suggest that, in the absence of dependable prognostic factors, regular individual monitoring of glomerular filtration rate can provide a reliable predictive estimate of the progression rate.     

Occurrence of Streptococcus pneumoniae and Haemophilus influenzae in otitis media with effusion

Eighty mucoid effusion samples obtained from 56 patients with otitis media with effusion (OME) were subjected to quantitative and qualitative bacteriological analysis using standard culturing methods, direct microscopy and immunofluorescent assay. 30% of the samples contained culture-positive pathogens (H. influenzae, S. pneumoniae, B. catarrhalis), with counts never exceeding 5 times 10⁵ per ml. In addition, 19% of the samples had dormant H. influenzae and S. pneumoniae, which did not grow on standard agar plates. Viable and dormant bacteria, as well as bacterial remnants, play a crucial role in the pathogenesis of OME and similarities between OME and reactive arthritis, i.e. Lyme arthritis, Reiter's syndrome and rheumatic fever, are evident.     

Studies of microleakage with restorative materials A new air pressure method

Abstract— A new method and apparatus are described for registering in vitro leakage of dental restorative materials. Methodological studies and studies of the error of the method were carried out. The method is based on the principle that the so-called space between the mould and the restorative material acts as a choke in a current of air. The air stream passed is an expression of the leakage due to available leakage area. The construction of the apparatus and its functions are illustrated in Figs. 1 to 4. The methodological studies showed that the method is suitable for comparative quantitation of leakage. The average area of leakage cannot be calculated. When leakage is registered, air flows into passages available for such leakage. The investigation of the error of the method showed that its precision is high.