Determination of steroid profiles in healthy and diseased states: identification and quantitation of a block of 17 alpha-hydroxylase

The steroid metabolic profile on a patient with a suspected block in steroid biosynthesis was analyzed by gas chromatography and gas chromatography-mass spectrometry. The results of this work led to an interpretation of a block at the 17 alpha-hydroxylase step. Although the steroid metabolic profile was complex, we could not detect any steroids with a hydroxy moiety at position C-17. The use of gas chromatography-mass spectrometry, in this case, was the method of choice for a final diagnosis because of the confusion that resulted from other, more classical, forms of analysis. Data from our patient's sample are reported and compared to normals and to other cases where a block in 17 alpha-hydroxylase have been reported.     

Facet "denervation" in the treatment of low back syndrome.

Long-term pain relief occurred in 21% of patients with low back and leg pain who underwent injection or radiofrequency rhizotomy. When pain was accompanied by unequivocal limitation of straight leg raising, neither injection nor rhizotomy produced long-term relief. Leg pain improved more than low back pain. Improvement was limited to pain relief as reported to the physician and reduction of medication. There was no improvement in work or activity status. Despite the low success rate, facet "denervation" is uncommonly safe and seems to be of some usefulness in the treatment of patients with low back pain and sciatica.     

The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment

Cognitive and behavioral pain coping strategies were assessed by means of questionnaire in a sample of 61 chronic low back pain patients. Data analysis indicated that the questionnaire was internally reliable. While patients reported using a variety of coping strategies, certain strategies were used frequently whereas others were rarely used. Three factors: (a) Cognitive Coping and Suppression, (b) Helplessness, and (c) Diverting Attention or Praying, accounted for a large proportion of variance in questionnaire responses. These 3 factors were found to be predictive of measures of behavioral and emotional adjustment to chronic pain above and beyond what may be predicted on the basis of patient history variables (length of continuous pain, disability status, and number of pain surgeries) and the tendency of patients to somaticize. Each of the 3 coping factors was related to specific measures of adjustment to chronic pain.     

Inhibition of brain glutamate decarboxylase by glutarate,glutaconate, and β-Hydroxyglutarate: Explanation of the symptoms in glutaric aciduria?

Glutaric aciduria is a disorcer of lysine, tryptophan, and hydroxylysine metabolism characterized by intermittent metabolic acidemia, dystonia, athetosis and mental retardation. It is due to a recessively inherited deficiency of glutaryl-CoA dehydrogeanse, the enzyme(s) which catalyze the dehydrogenation of glutaryl-CoA to glutaconyl-CoA and decarboxylation of the latter to crotonyl-CoA. Abnormal quantities of glutaric, beta-hydroxyglutaric, and glutaconic acids are found in the urine of these patients. The nature of the movement disorder prompted study of the effects of the abnormally excreted metabolites on brain glutamate decarboxylase, an enzyme implicated in the pathogenesis of Huntington's chorea. Glutamate decarboxylase activity was examined in rat and rabbit brain acetone powders, stabilized with pyridoxal phosphate and glutathione. Glutarate, beta-hydroxyglutarate, and glutaconate were competitive inhibitors of this emzyme, Ki values being 1.3 X 10(-3) mol/l, 2.5 X 10(-4) mol/l, respectively. This inhibition may explain the neurological accompaniments of this syndrome.     

Assessment of the acutely ill cancer patient

The process of assessing the acutely ill cancer patient must be organized and systematic. The framework outlined in this article provides a method that ensures complete and consistent data collection. These data can then be utilized to formulate specific patient problems and diagnostic statements and to form the basis for specific nursing actions.     

Antigen-specific immunoglobulins in patients with acute pulmonary, chronic pulmonary, or disseminated histoplasmosis

Patients infected with Histoplasma capsulatum exhibit protean clinical manifestations and similarly express variable humoral immune responses. Therefore, the specific goals of this study were to more clearly define host immune responses by determining the concentrations of total and H. capsulatum-specific immunoglobulins in sera from patients with acute or chronic pulmonary and disseminated histoplasmosis. H. capsulatum-specific (AS) IgG, IgA and IgM, and total IgE were determined by radioimmunoassays while total IgG, IgA, and IgM were quantitated by laser nephelometry. In general, total IgG and IgA were elevated, while IgM and IgE were either decreased or normal for the three clinical forms of histoplasmosis studies. Antigen-specific IgG and IgA were markedly elevated in all classes of disease, whereas AS-IgM was only slightly increased. Total and AS-IgG were elevated in the sera of chronic patients directly proportional to the number of demonstrable precipitin bands.     

Influenza B: hospital activity during a community epidemic

During a community epidemic of influenza B, surveillance throat cultures for influenza were collected from febrile adult patients and hospital employees on three medical wards to determine the frequency and source of influenza among hospitalized patients. Twenty-five cases of influenza B (18.5% of febrile patients) were identified; no clusters of influenza-like illness occurred. The attack rate on two wards was 4.6%. Peak hospital influenza incidence followed that in the community by 1-2 weeks. Twelve of the cases were community-acquired and 13 were nosocomial. 75% of community-acquired cases had three or more common influenza B symptoms, compared with only 39% of nosocomial cases. A viral etiology of fever was suspected clinically in one-half of the cases, but influenza was specifically suspected in only one case. Two ill culture-positive nurses were identified on the job but no asymptomatic carriers were found among ward personnel. We conclude that influenza B cases were present among hospitalized patients in the absence of recognizable clusters of disease and that patients with community-acquired illness as well as nursing personnel may have introduced influenza into the hospital. Influenza B may be difficult to diagnose clinically in hospitalized patients, but viral throat cultures performed in all suspected cases should identify many infected patients.     

Complications of the myeloproliferative system: Infection and sepsis

Living with cancer has become a more realistic hope for many patients as a result of newer combination-treatment modalities. However, impairment of the immune and inflammatory responses is a serious consequence of both aggressive disease and treatment.

Comprehensive nursing care during periods of granulocytopenia is critical to the survival of myelosuppressed patients. The primary nursing goals for these patients include (1) prevention of infection through promotion of the patient's optimal health status and reduction of environmental factors contributing to infection; and (2) early detection of infection through diligent assessment of the patient's health status, with prompt initiation of medical and nursing interventions.

Sepsis in the compromised cancer patient poses a major challenge in oncology nursing care. The importance of thorough nursing assessment and interventions to minimize exposure of the patient to potential pathogens during granulocytopenic periods cannot be overstated. The patient's life may well depend on it.     

The AVPR1A Gene and Its Single Nucleotide Polymorphism rs10877969: A Literature Review of Associations with Health Conditions and Pain

Background: Pain is the quintessential symptom for individuals suffering from sickle cell disease (SCD). Although the degree of suffering and the cost of treatment are staggering, SCD continues to be grossly understudied, including a lack of data for pain-related genes and prevalence of polymorphisms in this population. This lack of data adds to the inadequacy of pain therapy in this population. Pain genetics investigators have recently examined allele frequencies of single-nucleotide polymorphisms from candidate genes in people who have SCD. One of the genes identified was the arginine vasopressin receptor 1A gene (AVPR1A) and its associated single-nucleotide polymorphism (SNP) rs10877969. Progress in explaining pain-related polymorphisms associated with SCD can be facilitated by understanding the literature. Aim/Design: The purpose of this literature review was to describe mechanisms of the polymorphic gene AVPR1A and the phenotypic variations associated with its SNPs relative to health conditions and pain. Methods: Published studies were included if the research addressed AVPR1A and was a full article in a peer-reviewed journal, in the English language, a human or animal study, and published 2009 to present. Abstracts were included if they were in English and provided information not found in a full article. Results: The results of this review revealed that AVPR1A is associated with behavioral phenotypes, which include pair bonding, autism spectrum disorder, musical aptitude, infidelity, altruism, monogamy, mating, substance abuse, and alcohol preference. In addition, there were associations with pain, stress pain by sex, and sickle cell pain. Conclusion: Summary of this literature could provide insights into future pain research of this SNP in people with SCD.     

Correlation of E. coli K-1 bacteremia and capsular polysaccharide antigenemia in acute and chronic infection

The K-1 polysaccharide is an important virulence factor in human $\text{E. coli}$ infections. Using $\text{E. coli}$ 016K1, we investigated the kinetic association of bacteremia and K-1 antigenemia in acute lapine and canine infections and in a chronic infection model of neutropenic rats. Additionally, we assessed the presence of K-1 antigenemia in $\text{E. coli}$ K-1 bacteremic patients. K-1 was measured by a solid phase radioimmunoassay (RIA) using cross-reactive equine anti-Group B meningococcal IgM. In acute infections, none of the dogs or rabbits developed antigenemia even with a bacteremia of 2 × 10⁴ CFU/ml or 5 × 10⁵ CFU/ml, respectively. Antigenemia appeared in the rabbit only with an infecting dose of ? 5 × 10⁸ CFU. In the rat model we observed an initial bacteremia of 10³ CFU/ml, which increased to 10⁶ CFU/ml at 24 hrs. However, antigenemia was most often delayed, appearing in only ?30 hrs postinfection. Percent mortality was directly associated with the degree of bacteremia and antigenemia. In acute human $\text{E. coli}$ K-1 bacteremia, 11 of 22 (50%) of patients were positive for K-1 antigenemia. The data demonstrated that K-1 polysaccharide was not usually detectable in the early stages of bacteremia, but occured only after prolonged infection or very high infecting doses. The RIA to measure K-1 antigenemia would not be a useful diagnostic tool.