Nitric oxide modulates Na+, K+-ATPase activity through cyclic GMP pathway in proximal rat trachea

The present work demonstrated that nitric oxide (NO) modulates Na+, K+-ATPase activity in the proximal rat trachea. Sodium nitroprusside induced concentration-dependent (10-100 microM) stimulation in proximal trachea Na+, K+-ATPase activity. The effect was specific for Na+, K+-ATPase since Mg-ATPase activity was unaffected. This NO-donor changed neither Na+, K+-ATPase nor Mg-ATPase activity in the distal segment. The modulatory action on Na+, K+-ATPase induced by sodium nitroprusside was linked to an increase in nitrates/nitrites and cyclic GMP levels in proximal segments. Modulation of proximal Na+, K+-ATPase activity by sodium nitroprusside was mimicked by S-nitroso-N-acetylpenicillamine (100 microM) and 8-bromo-cyclic GMP (100 microM). Both sodium nitroprusside and 8-bromo-cyclic GMP effects on Na+, K+-ATPase activity of proximal segments of trachea were blocked by 2 microM of KT 5823 (a cyclic GMP-dependent protein kinase inhibitor), but not by 0.5 microM of KT 5720 (a cyclic AMP-dependent protein kinase inhibitor). Both kinase inhibitors decreased proximal Na+, K+-ATPase activity, but did not change Mg-ATPase activity. Okadaic acid (1 microM), a phosphatase-1 inhibitor, increased proximal Na+, K+-ATPase but not Mg-ATPase activity. The effect of okadaic acid was non-additive with that of 8-bromo-cGMP on Na+, K+-ATPase activity. Our results suggest that NO modulates proximal rat trachea Na+, K+-ATPase activity through cyclic GMP and cyclic GMP-dependent protein kinase.     

Indicators and standards proposal for the evaluation of the quality of hospital care: the case for bronchial asthma

The objectives of this article are to propose indicators for evaluation of the quality of hospital management of bronchial asthma patients, based on explicit criteria from literature reviews. The central problem identified in the literature review is the erroneous evaluation of severity of asthma crises, either by patients and their relatives, or by health professionals at all levels of care, causing serious consequences not only for the patient, but for society as a whole. Mortality figures indicate that from 1980 to 1990, an average of 2000 deaths per year from asthma occurred in Brazil, of which 70% occurred in hospital. Asthma was the fourth cause of hospitalization (hospital admissions), in the state of Rio de Janeiro in 1993. Only 12% of the admissions that resulted in death made use of the ICU. The above information highlights the need for a thorough evaluation of hospital care of bronchial asthma in Brazil, including a review of all admissions resulting in death and reviews of a sample of all bronchial asthma admissions. Proposed criteria are for this evaluation include: severity of the crise, treatment prescribed, information given to the patient and their relatives, and follow-up appointments made after discharge from hospital.     

Methodology to prevent mercury exposure among adolescents from goldmine areas in Mariana, state of Minas Gerais, Brazil

The main objective of this study was to promote the evaluation of an educational method to identify health risks among adolescents exposed to mercury by their work in gold mining production.The project was carried out with adolescents from a public school from the District of Monsenhor Horta, Municipality of Mariana, state of Minas Gerais. Statistical evaluation of the results revealed a significant increase in the amount of correct answers between the first and fifth stage concerning the definition of work accidents and its importance in relation to work-related diseases, accidents on route to and from the work place and violence at work site itself.     

Diagnosing CADASIL using MRI: evidence from families with known mutations of Notch 3 gene

Clinical data and MRI findings are presented on 18 subjects from two families with neuropathologically confirmed CADASIL. DNA analysis revealed mutations in exon 4 of Notch 3 gene in both families. All family members with mutations in Notch 3 gene had extensive abnormalities on MRI, principally lesions in the white matter of the frontal lobes and in the external capsules. Of several family members in whom a diagnosis of CADASIL was suspected on the basis of minor symptoms, one had MRI changes consistent with CADASIL; none of these cases carried a mutation in the Notch 3 gene. MRI and clinical features that may alert the radiologist to the diagnosis of CADASIL are reviewed. However, a wide differential diagnosis exists for the MRI appearances of CADASIL, including multiple sclerosis and small-vessel disease secondary to hypertension. The definitive diagnosis cannot be made on MRI alone and requires additional evidence, where available, from a positive family history and by screening DNA for mutations of Notch 3 gene. Received: 17 February 1999 Accepted: 23 July 1999     

Quadriceps and hamstrings peak torque ratio changes in persons with chronic anterior cruciate ligament deficiency

STUDY DESIGN: Cross-sectional analytical study in which subjects served as their own controls. OBJECTIVE: To assess the concentric and eccentric peak torque in the hamstrings and quadriceps muscles, hamstrings/quadriceps amplitude ratios, and lean thigh volume differences in the involved and uninvolved limb of subjects with anterior cruciate ligament (ACL) deficiency. BACKGOUND: Although the hamstrings/quadriceps ratios for concentric and eccentric activity have been studied, the more functional eccentric hamstings/concentric quadriceps ratio has not been previously described in chronic ACL deficient individuals. METHODS AND MEASURES: Eighteen subjects (36 +/- 11 years; 12 men, 6 women) with unilateral chronic ACL deficiency were recruited. Changes in activities of daily living, lean thigh volume (LTV) and isokinetic peak torque and total work capacity of both the quadriceps and hamstring muscles were investigated. The uninvolved limb served as control. RESULTS: Eccentric quadriceps peak torque in the ACL deficient limb was reduced by 38% compared with the 16% reduction of concentric quadriceps peak torque. Eccentric hamstrings peak torque was reduced by 15% compared with an 8% reduction in concentric hamstrings peak torque. LTV in the ACL deficient limb was 11% smaller than the uninvolved limb (3,541 +/- 899 vs 3,161 +/- 742 cc, uninvolved versus ACL deficient limb). The relation between LTV and eccentric peak torque was stronger in the uninvolved (r = 0.82) compared with the ACL deficient limb (r = 0.66). The eccentric hamstrings/quadriceps ratio was significantly higher in the ACL deficient (0.80 +/- 0.26) compared with the uninvolved limb (0.55 +/- 0.13). However, the eccentric hamstrings/concentric quadriceps ratio was similar between ACL deficient (0.75 +/- 0.17) and uninvolved (0.77 +/- 0.20) limbs, while the concentric hamstrings/eccentric quadriceps ratio was significantly higher in the ACL deficient (0.79 +/- 0.26) compared with the uninvolved (0.50 +/- 0.14) limb. CONCLUSIONS: Quadriceps and hamstrings peak torque values were significantly decreased in ACL deficient compared with the uninvolved limb. Eccentric muscle activity was affected to a greater degree than concentric muscle activity in the quadriceps muscle after ACL injury. The eccentric hamstrings/concentric quadriceps ratios were similar in ACL deficient and normal limbs, indicating that muscular co-ordination strategies may have been altered to maintain normal limb activity despite the strength losses particularly evident in quadriceps muscle function.     

Time course and predictors of symptoms after primary prostate cancer therapy.

PURPOSE: Understanding the distinctive patterns of treatment-related dysfunction after alternative initial treatments for early prostate cancer (PC) may improve patients' choice of treatment and later help them adjust to its consequences. We characterized the time course of treatment complications while adjusting for potentially confounding pretreatment factors hindering other observational studies. PATIENTS AND METHODS: In a prospective cohort study of 417 men we assessed urinary, bowel, and sexual function from before primary treatment to 24 months after. To control for potential confounding, we measured sociodemographic and PC prognostic factors, medical comorbidity, and pretreatment function commonly affected by PC and its treatment. RESULTS: Patients who underwent external beam radiotherapy (EBRT), radical prostatectomy (RP), and brachytherapy (BT) differed significantly in sociodemographic factors, cancer prognostic factors, and pretreatment symptom status, especially sexual function. Urinary incontinence increased sharply after RP, while bowel problems and urinary irritation/obstruction rose after EBRT and BT. Sexual dysfunction increased in all patients, particularly after radical prostatectomy, and nerve-sparing surgical technique had little apparent benefit. There was no change in urinary function and little change in overall bowel function after 12 months, but the time course of sexual dysfunction varied by treatment and, for bowel function, by symptom. Multiple regression modeling confirmed that treatment influences all 24-month outcomes, but residual confounding persisted. CONCLUSION: Pretreatment function and the primary treatment modality for early stage PC strongly predict the affected organ systems and time course of dysfunction. With this information, patients and their physicians may refine their choice of treatment and better anticipate its consequences.     

Tc-99m MDP uptake in uterine leiomyoma

A 47-year-old woman with adenocarcinoma of the right breast had bone scintigraphy with Tc-99m MDP. Bone imaging did not show any metastases. However, a large area of increased tracer uptake was seen extending from the abdomen to the pelvis. Abdominal ultrasound revealed a large solid and heterogeneous mass, measuring 18 x 11 x 14.3 cm, that originated in an empty uterus. A biopsy of the surgical specimen showed a leiomyoma of the uterus.     

MR diagnosis of a congenital abnormality of the thoracic aorta with an aneurysm of the right subclavian artery presenting as a Horner's syndrome in an adult

Congenital abnormality of the aortic arch is a diagnosis made most of the time incidentally in childhood, unless dysphagia or respiratory disorders occur before. A case of a complex aortic arch anomaly with an aneurysm of the right subclavian artery presenting as an isolated Horner's syndrome in an adult is reported herein. Magnetic resonance imaging led to this very unusual diagnosis. Received: 17 March 1999; Revised: 15 July 1999; Accepted: 13 August 1999