Brain natriuretic peptide and HIV-related cardiomyopathy

The brain natriuretic peptide (BNP) assay is a new, relatively inexpensive, and simple test that has the potential to be an early, cost-effective, and reliable marker for HIV-related cardiomyopathy. We report 1 case of HIV-related cardiomyopathy and 10 cases of of HIV infection with unknown heart disease in which we measured BNP levels and performed echocardiography. We found a significant inverse relationship between BNP and left ventricular function in these patients. Further basic and epidemiologic research on BNP measurement for the detection of HIV-related cardiomyopathy is needed to support these findings, which if confirmed, could have important clinical and public health implications.     

LH syndrome and brain catecholamine levels after lesions of the nigrostriatal bundle

Lesions of the nigrostriatal bundle (NSB), whose fibers pass through the medial portions of the internal capsule and the immediately adjacent lateral hypothalamus (LH), produced a more severe aphagia, adipsia, and disturbance of water regulation than did lesions of the medial forebrain bundle (MFB). When deprived of food, animals with NSB lesions drank significantly less than controls and animals with MFB lesions. NSB lesions also produced greater decreases in telencephalic content of the catecholamines than MFB lesions, while the reverse was true for serotonin. Water intake during food deprivation was highly correlated with telencephalic catecholamine levels in animals with NSB lesions. Thus, the inability to regulate water intake in the absence of food, one of the characteristic and long lasting effects of the LH syndrome, appears to be due to destruction of the NSB and the consequent decline in telencephalic content of catecholamines.     

Endocrinology and paracrinology: Roles of growth factors during peri-implantation development

Several growth factor ligand and receptor gene products havebeen shown to play roles during preimplantation mammalian development.Genes for insulin-like growth factors (IGFs), transforming growthfactors (TGFs), fibroblast growth factor (FGF), platelet-derivedgrowth factor (PDGF) and receptors for insulin, IGF, PDGF, TGFand epidermal growth factor (EGF) are expressed by early embryosof several species including mouse, rat, cow and sheep. Rolesof growth factors during early development have been demonstratedby addition of purified growth factors to culture medium orby molecular genetic techniques that interfere with gene expression.In this way, it has been shown that successful development ofthe blastocyst is dependent on the action of epidermal growthfactor (EGF) and leukaemia inhibitory factor (LIF). Recent experimentsshow that both LIF and EGF stimulate secretion of urokinase-typeplasminogen activator (uPA) and gelatinase B/ matrix metalloproteinase-9(MMP-9) in day 7 mouse blastocyst outgrowths. At the same time,tissue inhibitors of MMPs (TIMPs) are also expressed by embryonic,decidual and uterine tissues during the implantation process.It appears that LIF may act directly or indirectly, by inducingthe expression of other cytokines, to regulate the temporaland spatial production and activity of proteases and proteaseinhibitors to create a favourable environment for implantation.     

Stimulation of regulatory T cell circuits by immunoglobulin-dependent structures on activated B cells

An immunoregulatory circuit is described in which B cell blasts activate syngeneic Ly-1⁺2^?3^? T cells to (a) start a reaction which is indistinguishable from a graft-vs.- host reaction (syngeneic GvH) and (b) induce suppressor cell activity which abrogates the syngeneic GvH. Since capping the surface immunoglobulin (Ig) on B cell blasts blocks their ability to activate this circuit, it is likely that the relevant cell surface structure “seen” on the B cell by the Ly-1 T cell is either Ig itself or another molecule in association with Ig.     

Delayed pressure urticaria

Delayed pressure urticaria (DPU) is a poorly understood syndrome. We describe 17 patients with DPU. Chronic urticaria was present in 94%. All had negative challenges for immediate demographism and cold urticaria. DPU was induced with a pressure challenge on the shoulder of 15 pounds for 15 min. Average onset of pressure lesions after challenge was 6.5. Lesions were painful, not pruritic, peaked at 9 hr, and disappeared by 24 to 48 hr. Fever, chills, and/or arthralgias occurred in 78%. Positive laboratory abnormalities included leukocytosis in 20% and elevated erythrocyte sedimentation rate in 37.5%. Skin biopsies of lesions showed perivascular round cell infiltrates and negative immunofluorescence. Urticaria responded to antihistamines, but not aspirin, in 100% of patients, while pressure lesions improved with nonsteroidal anti-inflammatory drugs (NSAID), but not antihistamines, in 80% of patients. Both urticaria and DPU were controlled with prednisone, which was necessary in 87.5% of patients. A severe nonremitting course was noted in 7%, 40% had a moderate remitting course requiring intermittent prednisone, and 53% had a mild remitting disease requiring no medication or antihistamines and/or NSAID only. We conclude that DPU is more common than previously appreciated and likely involves mediators other than histamine, possibly the prostaglandin system.     

How are different types of continuity achieved? A mixed methods longitudinal study

BACKGROUND: In the context of developments in healthcare services that emphasise swift access to care, concern has been expressed about whether and how continuity of care, particularly interpersonal continuity, will continue to be achieved. AIM: To explore how patients regard and use primary care services in relation to continuity of provider and access to care, to identify factors that promote or hinder their success in achieving their preferences, and to describe what this means for how different types of continuity are achieved. DESIGN OF STUDY: Longitudinal, mixed methods. SETTING: Community in London and Leicester. METHOD: Purposive sample of 31 patients recruited from general practices, walk-in centres and direct advertising. Data collection involved in-depth interviews, consultation record booklets completed over 6 months and general practice records for the year including the study period. Data were analysed qualitatively. RESULTS: Four patterns were identified in the way patients used primary care. These were shaped by their own preferences, by the organisation and culture of their primary care practices, and by their own and their provider's efforts to achieve their preferences. Different configurations of these factors gave rise to different types of continuity. Patients were not always able to achieve the type they wanted. Patients with apparently similar consulting patterns could experience them differently. CONCLUSION: Within a programme of modernisation, policies that promote a commitment to meeting the preferences of different patients with flexibility and understanding are most likely to provide continued support for interpersonal and other types of continuity of care.     

Nutritional management of the adolescent athlete

The difference between the adolescent athlete and his mature counterpart is that this is a period of rapid physiologic growth and change. It is important that the additional stresses of athletic competition or preparation for that competition (such as weight reduction) do not compromise these changes. Providing the proper training diet for the adolescent athlete consists of providing adequate calories in the proper balance of nutrients for the additional stress of athletics. This must also take into account the eating patterns and preferences associated with adolescence. Education of coaches, parents, and athletes is an important aspect of providing health care to an athlete or athletic team. Although it may seem more "glamorous" to work with Olympic level or elite athletes, our experience is that these individuals often already have established poor eating patterns and nutritional misinformation. Clinics or educational sessions involving younger athletes will be more successful and build a foundation for tomorrow's Olympic athletes.