Analysis of bone mineral density in urolithiasis patients

BACKGROUND: The association between hypercalciuria and bone mineral density (BMD) has been already recognized. The aim of the present study is to relate BMD to age and sex and to evaluate the calcium metabolism and hypercalciuria-defined dietary or non-dietary category in patients with urolithiasis. METHODS: The BMI of the L2-L4 lumbar vertebrae was measured in 310 renal stone patients (191 men and 119 women). Percent age matched score (%AMS), which is the percent ratio of measured BMD to the mean BMD of age-matched control subjects, was utilized for the appraisal of BMD. Low BMD groups were defined by lower than 90% of %AMS. RESULTS: Low BMD was observed in 27.7% of urinary stone patients, which was not a significant difference to that of control subjects (23.5%) who were measured in the health examination. In male patients with urolithiasis, the frequency of patients in whom BMD had been apt to decrease since youth was high, but there was not a proven significant difference among the three age groups (20-39 years old, 40-59 years old and 60 years old or older). In contrast, for female stone patients, the frequency of low BMD markedly increased in patients aged 40 years or older, when menopause occurs. Furthermore, in female stone patients with hypercalciuria, the frequency of reduced BMD reached more than 40%. When the cause was non-dietary hypercalciuria (classified mainly on the daily amount of urinary calcium excretion after ingestion of calculus test diet), the frequency of reduced BMD reached 65% (P < 0.01). CONCLUSIONS: In case female stone patients with non-dietary hypercalciuria become menopausal, not only the risk of recurrent lithiasis increases, but the possibility of developing osteopenia in the future also increases. Appropriate treatments for prophylactic effects on urolithiasis or osteopenia should be considered, as judged from BMD, diet, sex, urinary calcium excretion and other factors synthetically.     

Effect of the season on the neurological outcome in children with cardiac arrest

Abstract Twenty children who were successfully resuscitated after cardiac arrest (CA) were retrospectively studied to examine the hypothesis that children with CA may have a worse neurological outcome in hot weather than in cold weather. Of 7 children with CA in the cold season (atmospheric temperature < 14^oC), 4 in the warm season (14-24^oC) and 9 in the hot season (> 24^oC). 5 (71%), 2 (50%), and 1 (11%), respectively, recovered consciousness (/³<0.05). Postresuscitative hyperthermia tended to be frequently observed in the group of children who suffered CA in the hot season, and it appeared to be associated with neurological damage. This preliminary study suggests that the neurological outcome of children with CA changes with the seasons, with a worse neurological outcome for CA in hot weather than in cold weather. A prospective study is required to determine whether, in a hot season or area, cooling of pediatric cardiac arrest victims during cardiopulmonary resuscitation on the scene improves the neurological outcome.     

Intestinal brush-border transport of the oral cephalosporin antibiotic,cefdinir, mediated by dipeptide and monocarboxylic acid transport systems in rabbits

Abstract— Intestinal absorption of the orally active cephalosporin, cefdinir, was investigated using brush-border membrane vesicles prepared from rabbit small intestine. The initial uptake of cefdinir was pH-dependent, with increased uptake at acidic pH, and was not influenced by either sodium gradient or membrane potential difference. Cefdinir uptake was saturable with an apparent Michaelis constant of 8·1 Mm . Initial uptake of cefdinir was inhibited by dipeptides (glycyl-l -proline and glycylsarcosine), β-lactam antibiotics (cephradine, cefixime and penicillin V), and monocarboxylic acids (acetic acid and l -lactic acid), whereas the uptake of cephradine and cefixime was not inhibited by monocarboxylic acids. Cefdinir significantly inhibited the initial uptake of cephradine, cefixime and [³H]acetic acid. From these results, it was suggested that cefdinir was transported across brush-border membranes by both dipeptide and monocarboxylic acid carriers.     

Inhaled nitric oxide followed by extracorporeal membrane oxygenation in resuscitating a newborn with hypoxemia

In a newborn requiring cardiopulmonary resuscitation because of hypoxemia due to sepsis (oxygenation index > 40), inhalation of nitric oxide (NO) in a concentration of 16p.p.m. improved oxygenation and restored spontaneous circulation. Cannulation for extracorporeal membrane oxygenation (ECMO) then was performed safely under NO inhalation. ECMO was discontinued on day 7, and on day 14 the infant was extubated. During follow-up examination at 5 months of age no neurological abnormalities were found. This case shows the usefulness of combining inhaled NO and ECMO.     

A New Instrument for Measurement of Gastrointestinal Mucosal Color

Abstract: We designed and produced a new instrument that measures the color of the gastrointestinal mucosa during conventional endoscopic examination. The instrument consists fundamentally of an optical fiber sensor and a light source. One end of the optical fiber sensor is connected to the light source and a commercially available spectrophotometric colorimeter, while the other end is passed through the biopsy channel of a commercially available endoscope and placed in contact with the gastrointestinal mucosa. The color of the mucosa is then measured. To evaluate the accuracy of color measurement, the instrument was used to measure the color of 108 color chips belonging to the color range of the gastrointestinal mucosa or surrounding regions, selected from the Munsell Book of Color. The instrument correctly determined the relative hue, chroma and value of all 108 color chips tested. It also had the advantages of consistently measuring the color chips under standardized conditions and of promptly displaying the color readings during endoscopic examination. This instrument was also used to measure the color of the mucosa at different sites of the upper gastrointestinal tract in 20 patients. There were no noteworthy problems in using the instrument clinically. Mucosal color (hue, value and chroma) of the upper gastrointestinal tract was demonstrated to have specific characteristics according to the region measured. The instrument provided highly accurate, objective information that facilitated the distinction of slight differences in mucosal color, an important factor in the endoscopic diagnosis of gastrointestinal diseases.     

Treatment of an infant with congenital sodium diarrhea by oral rehydration

We have been following a male case of congenital sodium diarrhea (CNaD), who had a distended abdomen, passed watery stools with high sodium concentration, and showed metabolic acidosis in the first week of life. He also showed hyponatremia, low urine sodium, high serum aldosterone and high renin activity. Other possible causes of secretory diarrhea were ruled out. The initial effective treatment was oral supplements of water and electrolytes lost in the fecal fluid: with this he gained weight, and hyponatremia and metabolic acidosis were corrected. Loperamide hydrochloride was administered to increase intestinal absorption of sodium, as the serum prostaglandin was high. Watery diarrhea then improved, but as he passed acholic stools, we stopped and postponed the treatment for a while; the stools then became watery again. Although diarrhea has persisted, he has not shown any abnormalities in growth or psychomotor development for the first two years of life.     

Modified endoscopic live donor nephrectomy: Retroperitoneoscopy followed by hand-assistance

We have developed a novel modification of previous approaches to donor nephrectomy and herein review our original operative procedure. First, the posterior aspect of the kidney was dissected retroperitoneoscopically and dissection of the renal artery, ureter and gonadal vein was almost completed. Second, the anterior aspect of the kidney was dissected with transperitoneal hand-assistance, and dissection of the renal pedicle from the anterior surface was accomplished easily and safely. This operative procedure was successfully performed for two donors with no intraoperative or postoperative complications. Our modified endoscopic donor nephrectomy is feasible as a minimally invasive procedure because of its safety, and its ability to preserve renal function and establish an excellent operative field for both posterior and anterior aspects of the kidney.