Renal excretion of endothelin in children

Endothelin (ET) is a peptide with profound vasoconstrictive potential. First isolated from porcine endothelial cell supernatant, it is produced also by smooth muscle, epithelial and circulating cells. Besides vasoconstriction, a wide spectrum of biological activities of ET (via activation of membrane receptors) has been described. These include regulation of other hormones and neurotransmitters, cellular growth and proliferation, bronchoconstriction, and, in the kidney, natriuresis and water diuresis. ET exerts its effects mainly in an autocrine and paracrine fashion. A high concentration of ET is found in urine, compared with plasma originating mainly from the kidney itself. In this review we focus on the role of urinary excretion of ET in children. ET excretion was determined under different physiological and pathological conditions. In premature infants and newborns, the daily excretion of ET (corrected for body surface) was higher than in older children; it was constant, and comparable to the values in healthy adults after the age of 2 years. Renal ET excretion correlated positively with urine flow in both healthy and sick children. Conditions with tubular and/or collecting duct cell damage, such as severe hypoxia, hemolytic-uremic syndrome, renal transplantation, diabetes mellitus, chronic renal failure, and contrast media cytotoxicity were characterized by elevated urinary excretion of ET. In conclusion, the renal excretion of ET is influenced by several factors, probably reflecting the intrarenal ET production. ET has a low specificity with regard to renal injury. Received May 7, 1996; received in revised form January 14, 1997; accepted January 17, 1997     

Post-traumatic facial paralysis without any fracture of the petrous bone]

Post-traumatic facial palsies are generally observed after a transverse, longitudinal or comminuted fracture of the pars petrosa. Occasionally, the fracture does not involve the Fallopian aqueduct and another mechanism must be sought. The authors present a case of facial palsy that occurred after a Le Fort's fracture of the base of the skull, not involving the Fallopian aqueduct on the CT scan. This was confirmed by surgical exploration. The authors recall the possibility of a facial palsy through the stretching of the nerve by the petrosal nerve.     

A "new" intraabdominal artery. The pedicled right gastroepiploic artery for myocardial revascularization.

The right gastroepiploic artery (GEA) was used as a pedicled conduit for direct coronary artery revascularization in 20 patients presenting with more or less exhausted saphenous vein resources. The early angiographic patency of the GEA conduit appears to be satisfactory when it is connected to the right coronary artery system. A distinct disadvantage of GEA grafting is the necessity to enter the abdominal cavity, which may lead to probably rare and as yet unrecognized morbidity. Future abdominal surgery may injure the GEA conduit unless its topographic relations to the prepyloric antrum, liver and diaphragm are properly recognized. The surgeon must then be prepared to encounter antegastric, retrogastric, antehepatic, transhepatic and retrohepatic routes of the redirected intraabdominal artery. The present paper addresses this problem. Preoperative angiography of the celiac trunk and superior mesenteric artery may be helpful in decision-making when a patient reports or records show that a graft has been harvested from the abdominal cavity.     

Screening for Depression in Patients with Chronic Illness

Why should depression screening be conducted in chronically ill populations? Depression is a disabling illness and is very common among patients who have chronic illnesses. Despite its high prevalence in this patient population, depression often goes unrecognized. Having a plan for a population-based screening program for depression can not only identify patients who are at risk of depression, but can also help to foster early treatment and enhanced care for these patients. This article provides an overview of commonly-used depression screening tools and presents an example of how this might be carried out in a healthcare organization.     

Activity of natural killer cells and granulocytes in peripheral blood and separated cells]

The natural killing of K 562 cells by whole blood from normal subjects was comparable with that shown by separated mononuclear cells. In order to establish the conditions for a reliable natural killer assay by using very small numbers of effector cells in whole blood, the isotope uptake of target cells was increased by a modified labelling method, which permitted the use of fewer target cells in the assay. The natural cytotoxicity of whole blood was augmented by interferon to the same extent as observed with separated mononuclear cells. The chemiluminescence of granulocytes in whole blood comparable with that of separated granulocytes. Taken together, these methods are considerably less tedious than the conventional methods, technique is also economical, and the results may reflect in vivo cytolytic processes much better.