Bench-to-bedside review: Resuscitation in the emergency department

Over the past decade the practice of acute resuscitation and its monitoring have undergone significant changes. Utilization of noninvasive mechanical ventilation, goal-directed therapy, restricted fluid volume, blood transfusion and minimally invasive technology for monitoring tissue oxygenation have changed the practice of acute resuscitation. Early diagnosis and definitive treatment of the underlying cause of shock remains the mainstay for survival after successful resuscitation. Patient-centered outcome end-points, in addition to survival, are being utilized to appraise the effectiveness of treatment. Application of medical ethics to the ever changing practice of acute resuscitation has also become a societal expectation.     

The overlooked, retained double J stent

A series of 4 patients with long overlooked, retained ureteral stents is presented to illustrate the variable, unpredictable, and at times, hazardous course of such patients. These cases are cited to re-emphasize the need for careful documentation, observation, and follow-up of patients in whom stents are placed.     

Tyrosine phosphorylation in mouse mammary hyperplasias

Tyrosine phosphorylation status was investigated during mousemammary tumor development using non-tumorigenic and tumorigenichyperplastic outgrowth lines. These outgrowth lines were comparedwith normal mammary glands from pregnant mice and with theircorresponding tumors. The levels of total tyrosine phosphorylationin proteins of hyperplastic and neoplastic tissues were 4.7-and3.4-fold higher than in the normal gland respectively. Theseresults indicate that increases in tyrosine phosphorylationoccur in the earliest stages of neoplastic development and arenot restricted to neoplastic cells per se. These results ledto the identification of the specific proteins showing highlevels of tyrosine phosphorylation. Of the eight molecular weightbands of proteins exhibiting detectable levels of tyrosine phosphorylation,the only proteins exhibiting consistently different degreesof phosphorylation between hyperplasias and tumors were of     

Mechanisms of resistance to Leishmania aethiopica. I. Interferon-gamma in combination with a cytokine (not tumor necrosis factor-alpha) is required, but cannot act alone in the inhibition of intracellular forms of L. aethiopica in THP1 cells.

Following exposure to promastigotes of various Leishmania species, mononuclear cells from non-exposed as well as potentially exposed individuals produced a cytokine response which inhibited intracellular forms of Leishmania aethiopica in a permissive monocytic cell line (THP1). Interferon-gamma (IFN-gamma), was one of the cytokines responsible for this anti-leishmanial effect. IFN-gamma was necessary for inhibition but could not act on its own inhibiting L. aethiopica. Tumor necrosis factor-alpha seemed not to be involved in the anti-L. aethiopica effect. The observed effects were in the absence of endotoxin. The results suggest that the mechanisms of killing of L. aethiopica in human cells may differ from those responsible for inhibition of other Leishmania parasites (such as Leishmania major) in mouse macrophages. Furthermore, that potentially relevant responses to Leishmania antigens may exist in normal individuals.     

The immunohistochemistry of Hodgkin's disease.

Immunohistochemistry is a valuable adjunct to the identification of Hodgkin's disease (HD) Reed-Sternberg (RS) cells, and in the differential diagnosis between HD, non-Hodgkin's lymphomas, and nonlymphoid neoplasms containing RS-like cells. The characteristic phenotype of RS cells in different subtypes of HD is described, with an emphasis on routine immunohistochemical stains. Some of the conflicting literature on this subject is reviewed to highlight pitfalls and controversies in the field.     

Soleus H-reflex measures in patients with focal and generalized dystonia.

OBJECTIVE: The purpose of this study was to examine neurophysiological characteristics of dystonia patients using electromyographic soleus H-reflex methods. METHODS: Thirty normal healthy individuals were compared to 27 patients with focal (cervical) or generalized dystonia. Three H-reflex assessment methods were included: the ratio of maximum H-reflex to direct muscle potential (H/M ratio); vibration inhibition (H(v)/H(c) ratio); and H-reflex recovery curves (HRRC). RESULTS: Average H/M ratios between groups were not statistically significant. The average H(v)/H(c) ratio for the generalized dystonia group was significantly greater than the focal dystonia and normal groups. Average values of the HRRC showed the generalized dystonia group had significantly greater disinhibition than the focal dystonia and control groups during the early inhibition phase. The HRRC for the focal dystonia group was greater than normal and more similar to the generalized dystonia group during the late phases of the recovery curve. The average value of the localized late facilitation phase for the focal dystonia group was significantly greater than the control group and less than the generalized dystonia group. No differences were observed between groups for the average localized late inhibition phase of the recovery curve. CONCLUSIONS: Soleus H-reflex measures identified neurophysiologic differences between generalized dystonia, cervical dystonia and normal conditions. SIGNIFICANCE: This methodology enables analysis of the underlying characteristics of dystonic pathologies using soleus H-reflex methods rather than upper extremity H-reflex techniques.