The urinary activity of angiotensin-converting enzyme in preterm, full-term newborns, and children

The urinary activity of the angiotensin-converting enzyme (U_ACE) is not yet completely documented in human neonates. We measured the U_ACE in 36 premature neonates on the 1st day and in the 1st, 2nd, 3rd, and 4th weeks of life, in 22 full-term neonates between the 1st and 2nd days, and in 30 nursing and preschool children between 1 month and 6 years of age. The urinary excretion of sodium (U_Na/U_Cr) and the potassium/sodium index (U_K/U_Na) were analyzed in the neonates. U_ACE was greater in premature than in full-term neonates and greater in both than in older children (p<0.001). In the premature neonates, U_ACE peaked at the 2nd week, the U_Na/U_Cr index decreased, and the U_K/U_Na index increased between the 1st day and the 2nd week (p<0.001). The U_Na/U_Cr index on the 1st day and in the 1st and 2nd weeks was greater in premature than in full-term neonates (p<0.001). There was no significant correlation between the U_ACE and the U_Na/U_Cr index. In conclusion, the U_ACE profile was shown to be age dependent and related to the postnatal renal development. The increase in U_ACE activity may reflect the high activity of the neonatal intrarenal renin-angiotensin system (RAS).     

Evaluating the hand: issues in reliability and validity

Evaluation of hand function is a qualitative and quantitative process. This article provides a review of several quantitative tests and measures used to evaluate range of motion, edema, muscle performance, sensation, dexterity, and physical capacity. The validity and reliability of these instruments are emphasized. Some of the hand assessments reviewed are in the early developmental phase with further refinements yet to come. This article demonstrates the continued need to provide support for the validity and reliability of hand-assessment instrumentation. Regardless of the statistical support provided, however, the authors believe that hand therapy will remain an art as well as a science.     

Acromioclavicular joint osteoarthritis: comparison of findings derived from MR imaging and conventional radiography

The purpose of this study was to determine the correlation between routine radiography and magnetic resonance (MR) imaging in the analysis of the acromioclavicular (AC) joint osteoarthritis (OA). MR imaging studies of the shoulder in 50 patients performed over a 1-year period at a single institution with corresponding conventional radiographic examinations performed within 1 month of the MR imaging study were restrospectively evaluated by the consensus of two musculoskeletal radiologists with special attention to the AC joint. As conclusion, information provided by conventional radiography in the analysis of AC joint OA does not correlate with that provided by MR imaging. AC joint OA is more frequently detected with MR imaging than with radiography. MR imaging provides better assessment of the full extent of AC joint OA and its effect on the underlying RC.     

Impact of intraoperative heparin on laparoscopic donor nephrectomy

PURPOSE: At many centers systemic heparinization is performed during laparoscopic donor nephrectomy because of concerns regarding graft thrombosis. However, no consensus exists in this regard. We evaluated the impact of intraoperative heparin on donor and recipient outcomes. MATERIALS AND METHODS: Between September 2000 and February 2003, 79 consecutive patients underwent laparoscopic live donor left nephrectomy at our institution. They were sequentially divided into 2 groups, that is group 1-the initial 40 patients who intraoperatively received 5,000 IU heparin intravenously and group 2-subsequent patients who did not receive heparin. The 2 groups were well matched demographically. Data were compared using the paired 2-tailed t test. RESULTS: The 2 donor groups were comparable in regard to mean blood loss (139 vs 179 cc, p = 0.59), intraoperative urine output (1.6 vs 1.6 l, p = 0.74), warm ischemia time (4 vs 4.2 minutes, p = 0.52), operative time (3.5 vs 3.5 hours, p = 0.97), and cold ischemia time (75 vs 82 minutes, p = 0.38). Complications occurred in 1 patient in group 1 (rhabdomyolysis induced acute renal failure) and in 2 in group 2 (chylous ascites and lumbar vein injury, respectively). No graft was lost due to vascular thrombosis in either group. Recipient immediate, early and delayed (6-month) graft function was comparable between the 2 groups. Acute rejection occurred in 5 recipients in group 1 and 1 in group 2. There was 1 recipient death per group at delayed followup. CONCLUSIONS: Routine use of heparin during laparoscopic donor nephrectomy is not necessary. Because of its potential for causing intraoperative or early postoperative hemorrhage, we no longer routinely administer intraoperative heparin during laparoscopic donor nephrectomy at our institution.     

The antiepileptic activity of JSTX-3 is mediated by N-methyl-D-aspartate receptors in human hippocampal neurons

We analyzed the effect of the acylpolyaminetoxin JSTX-3 on the epileptogenic discharges induced by perfusion of human hippocampal slices with artificial cerebrospinal fluid lacking Mg2+ or N-methyl-D-aspartate. Hippocampi were surgically removed from patients with refractory medial temporal lobe epilepsy, sliced in the surgical room and taken to the laboratory immersed in normal artificial cerebrospinal fluid. Epileptiform activity was induced by perfusion with Mg2+-free artificial cerebrospinal fluid or by iontophoretically applied N-methyl-D-aspartate and intracellular and field recordings of CA1 neurons were performed. The ictal-like discharges induced by Mg2+-free artificial cerebrospinal fluid and N-methyl-D-aspartate were blocked by incubation with JSTX-3. This effect was similar to that obtained with the N-methyl-D-aspartate receptor antagonist DL (-)2-amino-5 phosphonovaleric acid. Our findings suggest that in human hippocampal neurons, the antiepileptic effect of JSTX-3 is mediated by its action on N-methyl-D-aspartate receptor.