Retroperitoneal Laparoscopic Nephrectomy in Children

Retroperitoneal pediatric laparoscopic nephrectomy is described in 3 patients requiring 3 to 5 hours with an estimated blood loss of 10 to 60 cc. The children returned to school within 7 days postoperatively. Advantages of this procedure include the avoidance of intraoperative repositioning of the patient and easy conversion to an open lumbodorsal approach, if necessary; early laparoscopic visualization of the renal artery; applicability in cases of previous abdominal surgery, and avoidance of intraperitoneal adhesion.     

Geometric indices of bone strength are associated with physical activity and dietary calcium intake in healthy older women.

A population-based study on 1008 postmenopausal women identified that the 24% of women achieving high levels of PA and CI had 3.4-4.4% higher femoral bone strength in axial compression and 1.7-5.2% in bending than those achieving low levels, indicating that lifestyle factors influence bone strength in the proximal femur. INTRODUCTION: Extensive research has shown that increased physical activity (PA) and calcium intake (CI) decrease the rate of bone loss; however, there is little research on how these lifestyle variables affect bone geometry. This study was designed to investigate the effects of modifiable lifestyle variables, habitual PA and dietary CI, on femoral geometry in older women. MATERIALS AND METHODS: Femoral geometry, habitual PA, and dietary CI were measured in a population-based sample of 1008 women (median age+/-interquartile range, 75+/-4years) enrolled in a randomized controlled trial (RCT) of calcium supplementation. Baseline PA and CI were assessed by validated questionnaires, and 1-year DXA scans (Hologic 4500A) were analyzed using the hip structural analysis technique. Section modulus (Z), an index of bending strength, cross-sectional area (CSA), an index of axial compression strength, subperiosteal width (SPW), and centroid position, the position of the center of mass, were measured at the femoral neck (NN), intertrochanter (IT), and femoral shaft (FS) sites. These data were divided into tertiles of PA and CI, and the results were compared using analysis of covariance (ANCOVA), with corrections for age, height, weight, and treatment (calcium/placebo). RESULTS AND CONCLUSIONS: PA showed a significant dose-response effect on CSA all hip sites (p<0.03) and Z at the narrow neck and intertrochanter sites (p<0.02). For CI, there was a dose-response effect for centroid position at the intertrochanter (p=0.03). These effects were additive, such that the women (n=240) with PA in excess of 65.5 kcal/day and CI in excess of 1039 mg/day had significantly greater CSA (NN, 4.4%; IT, 4.3%; FS, 3.4%) and Z (NN, 3.9%; IT, 5.2%). These data show a favorable association between PA and aspects of bone structural geometry consistent with better bone strength. Association between CI and bone structure was only evident in 1 of 15 variables tested. However, there was evidence that there may be additive effects, whereby women with high levels of PA and CI in excess of 1039 mg/day had significantly greater CSA (NN, 0.4%; FS, 2.1%) and Z (IT, 3.0%) than women with high PA but low CI. These data show that current public health guidelines for PA and dietary CI are not inappropriate where bone structure is the health component of interest.     

Dietitians' perceptions about and personal nutrition practices for cancer risk reduction

This study was undertaken to examine the beliefs and practices of dietitians in relation to cancer risk reduction through nutrition. Respondents to the national survey (N=384, 70 percent) were similar in demographic, educational, and professional characteristics to the American Dietetic Association census data. They reported a strong preventive health orientation: mean performance on 10 preventive health behaviors was 77.5 on a 100 point scale. Half (53 percent) believed cancer would be serious if they developed it, 47 percent believed it was not likely that they would. About 20 percent of the respondents felt that the role of nutrition in cancer etiology was unclear. Dietitians believed strong research support existed for increasing whole grains, fruits and vegetables, and fiber to reduce cancer risk but that little evidence supported use of dietary supplements. Dietitians regularly practiced 75 percent of nutrition recommendations they believed to be effective in reducing cancer risk. Beliefs about the effectiveness of a recommendation accounted for the largest percentage of variance on nutritional practices. While dietitians reported many preventive health practices, including following nutrition recommendations, they seemed to be doing so for reasons other than preventing cancer.Nancie S. Merlino is Assistant Professor, Nutrition and Food Science, Wayne State University, Detroit, MI 48202 and James H. Price, Professor of Health Promotion, Department of Health Promotion, University of Toledo, Toledo, OH 43606.Acknowledgement goes to Stephen Jurs, PhD; Fredrick Andres, PhD; and John Kish, PhD for assistance in design and analysis.     

Continuous renal replacement therapy: the treatment of choice for acute renal failure

The health care issues facing society today are complex. Access to care, quality of life, relative value scales, diagnosis related groups, and cost containment demands have had an impact on the decision-making processes of health care professionals. The availability of alternative therapeutic treatment modalities adds additional considerations when prescribing medical therapy. This is especially true when a patient is diagnosed with renal failure. In the past, either peritoneal dialysis or hemodialysis have been the only therapies for supporting patients with acute renal failure. This article explores continuous renal replacement therapy for the management of acute renal failure: what it is, when and where it should be used, and the responsibilities of nephrology and critical care nurses and physicians.     

The distinction of bone and liver isoenzymes of alkaline phosphatase in serum using a monoclonal antibody

Out of 31 mouse monoclonal antibodies to human liver and bone ALP, one antibody coded BAP 1/9, showing a preference for binding the bone isoenzyme, and one antibody coded LAP 1/5, showing no preference, were selected to study binding of the serum forms of ALP. Using a plate capture assay format BAP 1/9 showed a 1.8-fold preference for binding purified bone versus liver ALP in the presence of 10% ALP-free serum compared with 2.1- to 2.25-fold preference in buffered salt solution. BAP 1/9 showed a preference for binding ALP from serum samples containing predominantly bone ALP compared to those containing predominantly liver ALP. Using predefined mixtures of serum forms of bone and liver ALP a linear relationship between ALP bound to BAP 1/9 and the fraction of bone ALP was obtained.