The incidence of seizures after rehydration of hypernatremic rabbits with intravenous or ad libitum oral fluids

Hypernatremic dehydration (mean plasma sodium, 184 mEq/L) was produced over a 3-5 d period in 71 rabbits. The dehydrated animals were divided into groups and rehydrated by intravenous (4, 6, and 8 h duration) or oral (4 and 24 h duration) solutions in amounts calculated to return plasma Na to 140 mEq/L. Plasma was obtained serially from each animal for electrolyte and osmolality determinations during dehydration and rehydration. Samples of brain hemisphere and cortex were obtained for chemical analysis from every animal immediately after death. The incidence of seizures was significantly less (P less than 0.025) in rabbits rehydrated orally when compared with rabbits rehydrated by the intravenous route. Brain water content was significantly greater in rabbits rehydrated intravenously when compared with normal rabbits and rabbits rehydrated orally. In addition, the amount of brain water was greater in rabbits with seizures when compared with those which did not have seizure manifestations. The mechanism underlying the significant reduction in seizures when the animals were rehydrated orally may relate to an integration of drinking behavior with rehydration status. Administration of oral fluids may provide an effective method of therapy for some patients with hypernatremic dehydration.     

Paucity of nutrition and food safety 'news you can use' reveals opportunity for dietetics practitioners

The media is consistently ranked by the public as their primary source of nutrition and food information. To address the question of what the public is hearing about food, nutrition, and health through the news media, the International Food Information Council Foundation commissioned the Center for Media and Public Affairs to conduct a content analysis of nutrition and food safety stories. The study examined media coverage from 53 print and electronic news outlets during a 3-month period from May through July 1995. Specific criteria were applied to select the sample of food and nutrition stories (n = 979) by length of coverage during the reporting period. Coverage related to food policy or regulation, food programs, individual food companies or products, advertising or marketing, and economic adulteration or tampering were excluded from the sample. The analysis of media coverage of food and nutrition topics revealed a twofold emphasis on dietary fat over other topics. Consumption of dietary fat was mentioned in almost half of all reports, apart from discussions of body fat, weight, or obesity as a health issue. The content analysis also showed an inverse relationship between media stories of foods by food group compared with the recommended number of servings in the Food Guide Pyramid. During an era in which Americans receive their health, nutrition, and food messages from the media rather than from health professionals such as physicians and dietitians, there are multiple challenges for communicating with the public. Our media research and its findings offer approaches for dietetics practitioners to use when providing nutrition and food recommendations and education for clients and the public. These include communicating science, providing context, reinforcing basic messages and guidelines, and promoting action and behavior change to clients and consumers.     

Common bile duct evaluation in the era of laparoscopic cholecystectomy. 1050 cases later.

OBJECTIVE: The authors documented the evolution of common bile duct (CBD) evaluation after the development of laparoscopic cholecystectomy (LC) and CBD exploration. Emphasis was placed on stratification of CBD stone risk so that subgroups could be selected appropriately for no further studies, preoperative endoscopic retrograde cholangiogram (ERC), or intraoperative intervention. METHODS: Data were accumulated by the authors on presentation, findings, and outcomes of 1050 patients who underwent cholecystectomies. Risk stratification was based on the history, ultrasound findings, biochemical derangements, and operative findings. RESULTS: Fifty-seven per cent of patients met criteria to be "no/low" risk for CBD stones (CBD diameter < 5 mm, normal liver enzymes, and no history of acute cholecystitis, jaundice, or pancreatitis); in these patients, cholangiograms were not obtained, and there was no clinical evidence of CBD stones observed in follow-up at 45 months (sensitivity = 100%). As techniques developed for laparoscopic CBD exploration, there was a decreased incidence of open cholecystectomy (p < 0.05) and preoperative ERC (p < 0.05). The rate of operative cholangiogram increased from 13% to 23% during the series (p < 0.01). There were no CBD injuries or late strictures. The only bile leak occurred from a peripheral segmental duct in the gallbladder bed and was resolved with a laparotomy and suture. There were no transfusions. Three retained stones were documented in patients who had false-normal operative cholangiograms. CONCLUSIONS: Criteria were defined that delineate a "no/low" risk group of LC patients for whom operative cholangiograms were not indicated for excluding CBD stones. The routine use of operative cholangiography as a means of preventing CBD injury was not substantiated by this study. The indications for preoperative ERC should continue to decrease as laparoscopic techniques evolve.     

Effect of cholecystokinin-octapeptide on opossum lower esophageal sphincter

We evaluated the action of cholecystokini-octapeptide (CCK-OP) on lower esophageal sphincter (LES) pressure in the opossum. LES pressure was recorded by an infused sleeve device that straddled the sphincter, whereas intraluminal esophageal pressure and gastric pressure were recorded via conventional manometric catheters. Progressive intravenous pulse doses of CCK-OP caused 1) graded increases in LES pressure, 2) circular and longitudinal smooth muscle contraction in esophageal body, and 3) mild increases in intragastric pressure. Pressor effect of CCK-OP on the LES was weakly antagonized by tetrodotoxin (TTX), but not by atropine, phentolamine, or pyrilamine. TTX antagonism of CCK-OP appeared to be nonspecific because TTX also partially antagonized LES contractions induced by pentagastrin, substance P, and bethanechol. We conclude that CCK-OP at doses that cause LES relaxation in other species induces LES contraction in the opossum. This pressor effect appears to be elicited by a direct action of the hormone on LES smooth muscle.     

Providing dust mite-proof covers improves adherence to dust mite control measures in children with mite allergy and asthma.

INTRODUCTION: The most critical dust mite avoidance technique for asthmatic children with mite allergy is the use of dust mite-proof bedding covers. Adherence to allergen control measures is poor due to cost. The purpose of this study was to determine whether giving families mite-proof bedding encasings at the time of the diagnosis with mite allergy would improve adherence at a home visit 2 months later. METHODS: Parents of children (mean age 7.7 years) with asthma and positive skin tests for dust mite were assigned either to an intervention group, which received dust mite covers upon enrollment or a comparison group, which did not. Both groups were instructed in dust mite control measures by a medical provider and told to invest in the covers as part of standard care. Two months after enrollment, parent report and observational measures from each family were obtained during a home visit. RESULTS: The group provided allergen encasings was found to be significantly more likely to have used the casings at the home visit, t(22) = 2.77, P < 0.05. There were no differences between groups in adherence to other mite control strategies. Parenting stress was significantly related to poorer mite control compliance. The most common reason reported for nonadherence to control measures was cost. CONCLUSIONS: Providing mite bedding encasings at the time of diagnosis significantly increases compliance at a 2-month home visit. Medicaid and insurance companies should be encouraged to pay for casings as a cost effective measure to improve asthma care in children with mite allergy.     

Clinical evaluation of 0.5% ferric hyaluronate adhesion prevention gel for the reduction of adhesions following peritoneal cavity surgery: open-label pilot study

The objective of this study was to assess the safety and to make a preliminary assessment of the efficacy of 0.5% ferric hyaluronate adhesion prevention gel in reducing adhesions in patients undergoing peritoneal cavity surgery by laparotomy, with a planned 'second-look' laparoscopy. The study was a randomized, open-label, placebo- controlled, parallel-group design in patients desirous of fertility at the Women's and Children's Hospital, Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, California. Female patients aged 24 to 41 years received 300 ml 0.5% ferric hyaluronate adhesion prevention gel or lactated Ringer's solution as an intraperitoneal instillate at the completion of the laparotomy procedure. At second-look laparoscopy 4-12 weeks after the laparotomy, the presence of adhesions was evaluated. Haematology and serum chemistry were determined throughout the study interval. All patients tolerated the procedures well and did not manifest any serious adverse events. At second-look laparoscopy, patients treated with 0.5% ferric hyaluronate adhesion prevention gel had significantly fewer adhesions than control patients. When adhesions did form, they were significantly less extensive and less severe in patients who received 0.5% ferric hyaluronate adhesion prevention gel. In conclusion, 0.5% ferric hyaluronate adhesion prevention gel was safe and highly efficacious in the reduction of the number, severity and extent of adhesions throughout the entire abdomen following peritoneal cavity surgery.      

Carcinoembryonic antigen family receptor recognition by gonococcal Opa proteins requires distinct combinations of hypervariable Opa protein domains

Neisserial Opa proteins function as a family of adhesins that bind heparan sulfate proteoglycan (HSPG) or carcinoembryonic antigen family (CEACAM) receptors on human host cells. In order to define the CEACAM binding domain on Opa proteins, we tested the binding properties of a series of gonococcal (strain MS11) recombinants producing mutant and chimeric Opa proteins with alterations in one or more of the four surface-exposed loops. Mutagenesis demonstrated that the semivariable domain, present in the first loop, was completely dispensable for CEACAM binding. In contrast, the two hypervariable (HV) regions present in the second and third loops were essential for binding; deletion of either domain resulted in loss of receptor recognition. Deletion of the fourth loop resulted in a severe decrease in Opa expression at the cell surface and could therefore not be tested for CEACAM binding. Chimeric Opa variants, containing combinations of HV regions derived from different CEACAM binding Opa proteins, lost most of their receptor binding activity. Some chimeric variants gained HSPG binding activity. Together, our results indicate that full recognition of CEACAM receptors by Opa proteins requires a highly coordinate interplay between both HV regions. Furthermore, shuffling of HV regions may result in novel HSPG receptor binding activity.