Abdominal hernias complicating continuous ambulatory peritoneal dialysis

Twenty-five percent of all CAPD patients reviewed in this study developed abdominal hernias. Eleven hernias (32.4%) occurred at the catheter insertion site, 17.6% were inguinal, 26.5% were epigastric and umbilical and 23.5% occurred at the site of previous abdominal incisions. The risk of developing a hernia was significantly greater in patients over 40 years of age, women of parity greater than 3, patients who had had undergone more than 3 laparotomies and those with a previous hernia repair. Three hernias became incarcerated, one with intestinal strangulation. Early surgical repair is advisable to avoid these complications.     

Health-promoting variables as predictors of response to a brief pain management program

This study investigated the value of the sense of coherence (SOC), self-esteem, and the Mental Health Inventory subscales as predictors of response to a brief pain management program. One hundred and seven chronic pain patients who participated in a pain management program, which included education about pain, relaxation training, and stress management, were sent a follow-up questionnaire 6 months after the course. Reported pain intensity since the course was significantly associated with SOC subscale meaningfulness. The use of relaxation and other techniques taught in the course was correlated with positive affect and well-being. The results suggest that health-promoting variables may offer advantages over pathological measures as predictors of patient response to pain management programs, and SOC is worthy of further study.     

Decreased insulin sensitivity during dietary sodium restriction is not mediated by effects of angiotensin II on insulin action

We have previously reported that modest dietary sodium restriction, as advocated in management guidelines for diabetes, may reduce insulin sensitivity. It has since been suggested that this effect may be mediated via cross-talk between insulin and angiotensin II (AII)-stimulated intracellular second messengers. In order to assess the effect of 5 days of modest sodium restriction (to <80 mmol/day target sodium intake) on insulin sensitivity, 15 healthy males underwent a double-blind, placebo-controlled, randomized, cross-over euglycaemic hyperinsulinaemic clamp study. One phase was supplemented with sodium tablets and the other with matched placebo. Insulin sensitivity (M) was reduced during dietary sodium restriction [median M value, 10.2 mg/kg per min (interquartile range 9.50-13.85) versus 12.8 mg/kg per min (interquartile range 9.60-14.30), P <0.05]. To elucidate potential mechanisms that may explain this observation, we investigated the effect of AII on insulin action in isolated adipocytes obtained from healthy females. No effect of AII on insulin-mediated glucose transport or suppression of lipolysis was observed. In conclusion, despite the observation that dietary sodium restriction was associated with a median 15% reduction in insulin sensitivity, we found no evidence of a direct effect of AII on insulin action in human adipocytes.     

Mixed lymphocyte reactivity and cell-mediated lympholysis to trinitrophenyl-modified autologous lymphocytes in C57BL/10 congenic and B10.A recombinant mouse strains

Cell-mediated lympholysis (CML) to trinitrophenyl (TNP)-modified autologous splenic lymphocytes has been recently reported in the mouse (1). Both the sensitization and effector phases of this phenomenon were shown to be T-cell mediated. Effector cell specificity studies indicated that modification of the target cells is a necessary but insufficient requirement for cytolysis, and suggested that altered cell surface components controlled by genes mapping in the mouse major histocompatibility H-2 complex (MHC) are important in the specificity of the cytotoxic reaction (1). In allogeneic models the generation of cytotoxic effector cells has been shown to be preceded or accompanied by immunogen- induced proliferation of responding lymphocytes, i.e. a mixed lymphocyte reaction (MLR) (2-5), although the generation of effectors may not necessarily always be the consequence of extensive cell proliferation (5). If the induction of cytotoxic effector lymphocytes by modified syngeneic spleen cells is characteristic of sensitization with cellular alloantigens, one would expect to find that sensitization with TNP-modified autologous cells would also induce thymidine incorporation by the responding cells in the culture. The present report demonstrates that both stimulation of thymidine incorporation and generation of cytotoxic effector cells are part of the in vitro response to TNP-modified autologous lymphocytes. However, the MLR to TNP- modified autologous cells consistently appeared to be less pronounced when compared with an allogeneic MLR, whereas the cytotoxic activity of the effector cells generated by sensitization against TNP-modified autologous cells was frequently as high as that detected against H-2 alloantigens. These two components of reactivity to “modified self” are verified in several C57BL/10 congenic and B10.A recombinant mouse strains.