Assessment of retinol-binding protein excretion in normal children

Retinol-binding protein (RBP) is a low molecular weight protein freely filtered at the glomerulus. The fractional tubular reabsorption of RBP is 99.97% and increased excretion is therefore a sensitive marker of tubular dysfunction. We obtained early-morning urine specimens from 151 well children, from newborn to 16 years of age. RBP was measured using an enzyme-linked immunosorbent assay, albumin by a radioimmunoassay and creatinine by a modified Jaffé reaction. Protein excretion was assessed by calculating the protein: creatinine ratio for early-morning urine samples. We found a fall in both RBP and albumin excretion with increasing age, particularly in the 1st year of life, with a much wider variation in values from the infants studied. The mean excretion of RBP for children aged 0–6 months [51.4 (0.6–4,719) g/mmol] was significantly higher (P<0.001) than the mean for children aged 6 months to 16-years [15.0 (3.8–60) g/mmol]. It has been shown that measurement of tubular proteinuria using the RBP: creatinine ratio is useful in the assessment of children with renal disease and we propose a value two standard deviations above the geometric mean for the age of the patient as an upper limit of normal.     

A clinical evaluation of the Terumo Capiox SX18R hollow fiber oxygenator

The Terumo Capiox SX18R is a commercially available, low prime, reverse phase, hollow fiber membrane oxygenator. The oxygenator consists of a 1.8 m2 microporous polypropylene hollow fiber bundle, a 2200 cm2 tubular stainless steel heat exchanger, and an open hard shell venous reservoir with integral cardiotomy filter. The Terumo Capiox SX18R oxygenator was evaluated to determine its clinical oxygenating performance. Blood samples were drawn from 25 patients yielding 114 data points. The following parameters were recorded: blood flow, cardiac index, gas flow, gas to blood flow ratio, and oxygen fraction. Samples were assayed for hematocrit, hemoglobin, arterial and venous blood gas values, and venous oxygen saturation. The data and assay results were used to calculate arterial, venous, and membrane gas oxygen content, oxygen transfer, shunt fraction, and oxygen diffusion capacity. The Terumo Capiox SX18R oxygenator performed adequately with sufficient oxygen transfer reserve and carbon dioxide clearance under a variety of clinical conditions for the tested population.     

Staffing issues at open-heart centers offering both pediatric and adult perfusion service: 1998 survey results

A survey directed to centers offering both pediatric and adult perfusion services was conducted to determine how pediatric cases were distributed among individual perfusionists in their departments. These centers were also asked what they believed the clinical activity level should be for a perfusionist each year to remain proficient in pediatric cardiopulmonary bypass. The questions were asked via e-mail and then followed up with telephone interviews as necessary. Out of the 100 centers contacted, 45 responded to the survey (43 North American, 2 European). Of the forty-five centers, forty-one provided both pediatric and adult perfusion services. Thirty-two centers (78%) offering adult as well as pediatric perfusion services distributed the pediatric caseload to a select group of perfusionists. Nine centers (22%) distributed the pediatric open-heart caseload to the entire staff. From the respondents, the average minimum number of pediatric cases believed necessary to remain proficient in pediatric perfusion was 42.8 cases annually. Centers having dedicated pediatric perfusionists had a slightly higher annual caseload than did those at non-specialized centers, despite practicing at institutions averaging fewer pediatric open-heart cases annually.     

The psychosocial context of Black women's health

Researchers have demonstrated that Black women exhibit a disproportionate risk of ill health. We examined the relationship between psychosocial factors, including economic status, race-based social inequality, gender-based violence, and the health status of 323 Black women between the ages of 18 and 65. Black women from a community sample completed a health survey with open-ended responses. Results indicated that women in lower economic groups are more likely to be treated for allergies (p = < .05) and pelvic inflammatory disease (PID; p = < .01). Women who experienced increased incidents of race-based social inequality received more medical treatments for yeast infections, pregnancy-related problems, allergies, and PID. Those with histories of physical, psychological, and early sexual abuse are more likely to be treated for depression, allergies, yeast infections, and hypertension. In addition, qualitative data examined the process in which economic, race-based social inequality, and gender-based violence contributed to the ill health of Black women. The implications of these findings suggest that understanding the psychosocial context is essential for appropriate clinical practice. Additionally, future research should conceptualize health as a complex interaction of psychosocial risks that have a profound effect on the health status of Black women.     

How likely is it that Stockholm stage 1 of the hand arm vibration syndrome will progress to stages 2 and 3?

The progression of symptoms in the hand arm vibration syndrome (HAVS) is dependent on the interaction of individual and workplace factors. Workplace factors include type, magnitude and intermittency of exposure to hand transmitted vibration (HTV), anti-vibration tool design and workpiece characteristics. Individual susceptibility and constitutional factors are poorly understood and the reliance on anamnesis for diagnosis can lead to recall bias, inaccurate classification and an unreliable assessment of the stage of deterioration. This may be overcome by the adoption of multiple standardized testing. The introduction of a policy covering identification, risk assessment, health surveillance and reasonably practicable control measures will have the most significant impact on the incidence of new cases and deterioration in established cases.     

Flumazenil-precipitated panic and dysphoria in patients dependent on benzodiazepines: a possible aid to abstinence

Ten long-term users of benzodiazepines (average daily dose, 20 mg of diazepam or equivalent) who had experienced problems in withdrawing from the drugs were given an i.v. challenge with either the benzodiazepine antagonist flumazenil (1 mg injected over 30 s) or placebo (vehicle solution) in a randomized double-blind design. There were no 'pseudo withdrawal' responses to either single-blind or double-blind placebo injections, whereas flumazenil produced dramatic panic reactions in all four subjects tested, followed by characteristic benzodiazepine withdrawal symptoms. There were also small but significant rises in pulse rate and blood pressure, but no change in serum cortisol. Flumazenil-induced panic could not be entirely accounted for by a past or present diagnosis of panic disorder, and did not seem to be related to previous withdrawal problems, present benzodiazepine dosage, or to the severity of withdrawal symptoms precipitated by flumazenil in the same challenge test. Attempts to reduce benzodiazepine intake over the next 3 weeks tended to be more successful in the flumazenil group. The results are discussed with reference to possible changes in the GABA-benzodiazepine system in long-term benzodiazepine users.     

Comparative pharmacokinetics of propofol in Chinese adults and children.

The pharmacokinetics of propofol were studied in 14 healthy young male Chinese adults, aged 18-38 years, undergoing minor orthopedic surgery. All patients who received a single bolus dose of propofol 2.5 mg/kg were paralyzed with atracurium and mechanically ventilated. Anesthesia was maintained with 67% nitrous oxide plus 1-2% isoflurane in oxygen with alfentanil 5 micrograms/kg intravenously as a bolus injection. Blood concentrations of propofol over the subsequent 24 hours were measured using high pressure liquid chromatography with fluorimetric detection. Data were consistently described by a three compartment model but analysis revealed two significantly different blood propofol concentration-time profiles (p less than 0.05). Five patients, designated "fast" metabolizers, demonstrated a mean elimination half-life which was shorter than that described in Chinese children, while their total body clearance was similar. Nine other patients, designated "slow" metabolizers, had a longer mean elimination half-life and slower total body clearance than those in elderly Caucasian patients. This may be suggestive of propofol metabolism at some extra-hepatic site in some patients, while other patients demonstrate marked lipophilicitic constraint of the drug by the deep compartment.     

Prodigious alcohol consumption by Australian rugby league footballers

As an incidental finding in a general 'life-style' survey, amateur rugby footballers were found to drink prodigious (12-24 schooners per session) quantities of beer. Such drinking was regarded by the players as part of the traditions of mateship associated with the game. The need for intervention is discussed.