Antihypertensive response to prolonged tempol in the spontaneously hypertensive rat

INTRODUCTION: Tempol is a permeant nitroxide superoxide dismutase (SOD) mimetic that lowers mean arterial pressure (MAP) in spontaneously hypertensive rats (SHRs). We investigated the hypothesis that the antihypertensive response entails a negative salt balance, blunting of plasma renin activity (PRA), endothelin-1 (ET-1), or catecholamines or correction of oxidative stress as indexed by 8-isoprostane prostaglandin F(2alpha) (PGF(2alpha)) (8-Iso). METHODS: Groups (N= 6 to 8) of SHRs were infused for 2 weeks with vehicle or tempol (200 nmol/kg/min) or given tempol (2 mmol/L) in drinking water. RESULTS: Tempol infusion reduced the MAP of anesthetized SHRs (150 +/- 5 vs. 126 +/- 6 mm Hg) (P < 0.005). Oral tempol did not change the heart rate but reduced the MAP of conscious SHRs (-23 +/- 6 mm Hg) (P < 0.01) but not Wistar-Kyoto (WKY) rats. Tempol infusion increased the PRA (2.2 +/- 0.2 vs. 5.0 +/- 0.9 ng/mL/hour) (P < 0.005), did not change excretion of nitric oxide (NO) [NO(2)+ NO(3) (NOx)], ET-1, or catecholamines but reduced excretion of 8-Iso (13.2 +/- 1.4 vs. 9.6 +/- 0.9 ng/24 hours; P < 0.01). Cumulative Na(+) balance and gain in body weight were unaltered by tempol infusion. Tempol prevented a rise in MAP with high salt intake. CONCLUSION: Tempol corrects hypertension without a compensatory sympathoadrenal activation or salt retention. The response is independent of nitric oxide, endothelin, or catecholamines and occurs despite increased PRA. It is accompanied by a reduction in oxidative stress and is maintained during increased salt intake.     

A comparison of hemiarthroplasty and total shoulder arthroplasty in the treatment of primary glenohumeral osteoarthritis: results of a multicenter study

Six hundred one total shoulder arthroplasties and eighty-nine hemiarthroplasties were performed for primary osteoarthritis of the shoulder. Patients were evaluated with a physical examination, Constant score, and radiographic evaluation. The minimum follow-up was 2 years. At follow-up, the Constant score averaged 64 points, the adjusted Constant score averaged 86%, active anterior elevation averaged 130 degrees, and active external rotation averaged 36 degrees for the hemiarthroplasties. The Constant score averaged 70 points, the adjusted Constant score averaged 96%, active anterior elevation averaged 145 degrees, and active external rotation averaged 42 degrees for the total shoulder arthroplasties. Eighty-six percent of hemiarthroplasties and ninety-four percent of total shoulder arthroplasties had good or excellent results. Differences were statistically significant for all parameters. Total shoulder arthroplasty provided better scores for pain, mobility, and activity than hemiarthroplasty. Fifty-six percent of total shoulder arthroplasties had a radiolucent line around the glenoid component. Total shoulder arthroplasty provides results superior to those of hemiarthroplasty in primary osteoarthritis.     

Hindfoot arthrodesis for the adult acquired flat foot

This article reviews hindfoot arthrodesis for the adult acquired flat foot. Discussion of triple arthrodesis, triple arthrodesis with the addition of a lateral column lengthening procedure, triple arthrodesis with the addition of a plantar flexion first metatarsoncuneiform arthrodesis, and an isolated subtalar arthrodesis are discussed. The indications, surgical techniques, outcome studies, and complications are addressed.     

Gastrointestinal Kaposi's sarcoma as the first manifestation of acquired immunodeficiency syndrome.

Gastrointestinal Kaposi's sarcoma can occur in HIV-infected patients without previously diagnosed AIDS. Gastrointestinal symptoms in such patients should be thoroughly investigated because of the possibility of gastrointestinal Kaposi's sarcoma, despite the absence of the cutaneous form. The discovery of gastrointestinal Kaposi's sarcoma establishes the diagnosis of AIDS, as it did in our two patients.     

Biochemical recurrence rate in patients with positive surgical margins at radical prostatectomy with further negative resected tissue

OBJECTIVE

To determine the biochemical recurrence (BCR) rate in patients with positive surgical margins (PSMs) on the prostate specimen who have additional negative tissue resected from that site (M+ ?), compared to patients with negative margins (M?) and those with persistent PSM (M+), as those with PSM at radical prostatectomy (RP) are at greater risk of BCR, and in some instances where suspicious tissue is noted in the prostate bed or when frozen‐section analysis shows PSM, additional tissue is resected from the suspect site of the PSM.

PATIENTS AND METHODS

Between January 1999 and June 2007, 4217 consecutive patients underwent open or laparoscopic RP with no previous radiotherapy or hormonal therapy. The median (interquartile range) follow‐up was 37.4 (21.1–60.7) months.

RESULTS

Pathological organ‐confined (OC) cancer was present in 2901 men, of whom 2659 had M?, 216 had M+, and 26 had M+ ?. Extracapsular extension (ECE) alone with no seminal vesicle or lymph node involvement was present in 843 men, of whom 657 had M?, 174 had M+ and 12 had M+ ?. For patients with OC cancer, the 36‐month actuarial BCR‐free probability was 97.9% (95% confidence interval 97.3–98.5) for M?, vs 89.0 (84.1–93.9)% for M+ vs 100% for M+ ?. For patients with ECE, the 36‐month actuarial BCR‐free probability was 83.7 (80.0–87.4)% for M? vs 73.7 (66.1–81.3)% for M+ vs 90.0 (71.4–100)% for M+ ?. The main limitation of the study was its retrospective nature, with the reason for resection of additional tissue not always well documented.

CONCLUSIONS

While the few patients with PSMs and further negative resected tissue limited the statistical analysis, it would appear that in these patients the disease behaves as in those with negative margins.     

Does laparoscopic surgery decrease the risk of atrial fibrillation after foregut surgery?

Background  Atrial fibrillation, which occurs in 12% of all major foregut surgeries, can prolong hospital stay and increase morbidity. Minimally invasive techniques in foregut surgery have been suggested to cause less tissue trauma. We examined the factors associated with new-onset atrial fibrillation after foregut surgery at our institution. Methods  We retrospectively examined the records of 154 adult patients who underwent major foregut surgery which included esophagectomy, partial or total gastrectomy, redo Heller myotomy, redo or transthoracic fundoplications. Univariate and multivariate logistic regression analysis with standard modeling techniques were performed to determine risk factors for new-onset atrial fibrillation. Results  Of the 154 patients, 14 patients developed new-onset atrial fibrillation with a higher mean age of 67.1 years (±8.8 years) versus 56.4 years (±14.1 years) (p = 0.006). Laparoscopic (p = 0.004) and nonthoracic surgeries (p = 0.01) were associated with lower risk of atrial fibrillation. Patients with atrial fibrillation had received more fluid (6.5 ± 2.8 liters versus 5.3 ± 2.0 liters) and had longer operations (370 ± 103 min versus 362 ± 142 min), none of which were statistically significant. The average intensive care length of stay of patients was longer: 7.5 ± 6.8 days versus 4.0 ± 7.1 days (p = 0.004). Multivariate analysis revealed an association of atrial fibrillation with age (OR 1.08, 95% CI 1.02–1.14, p = 0.01), and laparoscopic surgery (OR 0.09, 95% CI 0.01–0.95, p = 0.04) after adjusting for surgery type. Conclusions  Laparoscopic surgery is associated with lower risk of atrial fibrillation in foregut surgery. Development of atrial fibrillation is associated with increased length of intensive care stay. We recommend a prospective trial to confirm our findings.     

Upper gastrointestinal bleeding from Merkel cell carcinoma.

Merkel cell carcinoma is a rare small cell carcinoma of the dermis with aggressive clinical features and frequent local recurrence. Intra-abdominal spread of the cancer has previously been noted primarily in the liver and retroperitoneal nodes. We report a patient with previously diagnosed Merkel cell carcinoma of the right buttock with metastases to the stomach and duodenum presenting with acute upper gastrointestinal bleeding.     

Gastrointestinal blood loss associated with running a marathon

Gastrointestinal bleeding has been observed in long-distance runners. We prospectively studied participants of the Eighth Annual Marine Corps Marathon to determine the incidence of gastrointestinal blood loss associated with long-distance running. Of 600 runners contacted, 125 (21%) returned a questionnaire as well as pre- and postmarathon stool specimens. Stool specimens converted from Hemoccult negative to positive in 29/125 (23%) of the participants, indicating that running the marathon was associated with gastrointestinal blood loss (P<0.001). The incidence of this conversion (negative to positive) was significant for both males (N=68,P<0.001) and females (N=57,P<0.05). Gastrointestinal bleeding appeared to be independent of age, race time, abdominal symptoms, and the recent ingestion of aspirin, vitamin C, or steak.The opinions and assertions contained herein are the private views of the authors and are not to be construed as official policy or as reflecting the views of the Department of the Army or the Department of Defense.