Radiographic detection of perflubron fluoromediastinum and fluororetroperitoneum 9 years after partial liquid ventilation

A 17-year-old patient presented, after a motor vehicle collision, with right hip pain and unusual radiographs of the chest and pelvis. Multiple radiopacities obscured detail. These partly obscured and distracted attention from a right acetabular fracture. The etiology was persistent perflubron 9 years after partial liquid ventilation for acute respiratory distress syndrome. Persistence of perflubron beyond 138 days has not been previously reported. We review the imaging appearance of perflubron and the mechanism likely related to its distribution and persistence in this case, and emphasize the importance of obtaining clinical history and avoiding distraction when faced with unusual radiographic findings.     

Induction Of Endothelin-1 Expression By Glucose: An Effect Of Protein Kinase C Activation

Enhanced actions or levels of endothelin-1 (ET-1), a potent vasoconstrictor, have been associated with decreased blood flow in the retina and peripheral nerves of diabetic animals and may be related to the development of pathologies in these tissues. Hyperglycemia has been postulated to increase ET-1 secretion in endothelial cells. We have characterized the mechanism by which elevation of glucose is increasing ET-1 mRNA expression in capillary bovine retinal endothelial cells (BREC) and bovine retinal pericytes (BRPC). Elevation of glucose, but not mannitol, from 5.5 to 25 mmol/l for 3 days increased membranous protein kinase C (PKC) activities and ET-1 mRNA in parallel levels by 2-fold in BREC and BRPC. These effects were reversed by decreasing glucose levels to 5.5 mmol/l for an additional 2 days. Glucose-induced ET-1 overexpression was inhibited by a general PKC inhibitor, GF109203X, and a mitogen-activated protein kinase kinase inhibitor, PD98059, but not by wortmannin, a phosphatidylinositol 3-kinase inhibitor. By immunoblot analysis, PKC-beta 2 and -delta isoforms in BREC were significantly increased relative to other isoforms in the membranous fractions when glucose level was increased. Overexpression of PKC-beta 1 and -delta isoforms but not PKC-zeta isoform by adenovirus vectors containing the respective cDNA enhanced in parallel PKC activities, proteins, and basal and glucose-induced ET-1 mRNA expression by at least 2-fold. These results showed that enhanced ET-1 expression induced by hyperglycemia in diabetes is partly due to activation of PKC-beta and -delta isoforms, suggesting that inhibition of these PKC isoforms may prevent early changes in diabetic retinopathy and neuropathy.     

PROGRESSIVE SUPRANUCLEAR PALSY PRESENTING WITH PSYCHIATRIC FEATURES

SUMMARY A patient with progressive supranuclear palsy who presented with psychiatric features is reported. His case illustrates the difficulty of early diagnosis of this condition. Associated psychiatric symptoms are common and may precede the occurrence of gaze palsy. Our patient's behavioural problems responded to fluoxetine.     

Work sampling. Analyzing nursing staff productivity

Most managers have only a vague idea of how their employees spend their time. Work sampling is a technique that can identify the types of activities that staff perform and the amount of time that they spend on each activity. With this information, managers can make decisions regarding allocation of staff and activities, thereby increasing efficiency and effectiveness of personnel. This paper describes the use of work sampling as a technique to study employee time allocation and productivity. It offers suggestions for planning, implementation, and utilization of the results of a work sampling study. A work sampling study conducted at the University of Michigan Medical Center's Psychiatric Nursing Department is used as an example.