The provision of public health nursing follow-up services for postnatal clients in Ontario: a cross-sectional survey.

We did a cross-sectional survey of official health agencies in Ontario in 1990 to assess methods of providing postnatal services. The response rate was 78.6%. We found that diverse methods of postnatal follow-up are offered although home visits remain a primary mode of service delivery. There are significant differences in the timing of home and telephone visits and postnatal group sessions.     

Helical CT of calcaneal fractures: technique and imaging features

 Since the degree of comminution, fracture alignment, and articular congruity of intra-articular calcaneal fractures are important determinants in surgical treatment and patient prognosis, we review helical computed tomographic (CT) technique and features for detecting and assessing the extent of acute calcaneal fractures. Helical CT can be used to classify these fractures and facilitate the surgeon’s understanding of the anatomy and position of the fracture components in all orthogonal planes independently of the patient’s condition, foot placement in the CT gantry, or other injuries.     

Diagnostik und Therapie von Harnstoffzyklusdefekten

Zusammenfassung Fragestellung: Es werden die Verl?ufe von 8 Patienten mit St?rungen der Harnstoffsynthese [Carbamylphosphatsynthetasemangel (4), Citrullin?mie (2) und Argininosuccinatlyasemangel (2) ] beschrieben. Methode/Therapieprinzipien: Akuttherapie: Na-Benzoat und Arginin i. v., dazu Peritonealdialyse und/oder H?modiafiltration. Lanfristige Therapie: proteinreduzierte Ern?hrung, Substitution essentieller Aminos?uren, Na-Benzoat bzw. Na-Phenylbutyrat oral, Substitution von verzweigtkettigen Aminos?uren. Ergebnisse: Sp?testens 3 Tage post partum entwickelte sich nach initialer Alkalose ein hyperammon?misches Koma mit Hirn?dem, das zu deutlichen Residualsch?den führte. Vier Patienten verstarben zwischen der 2. Lebenswoche und dem 4. Lebensjahr aus unterschiedlichen Gründen. Hyperammon?mien traten bei allen Patienten auf und lie?en sich konservativ beherrschen. Na-Phenylbutyrat verursachte weniger gastrointestinale Nebenwirkungen als Na-Benzoat, verzweigtkettige Aminos?uren hatten einen positiven Effekt. Ein Patient wurde vom 1. Lebenstag an medikament?s behandelt, die Entwicklung verlief altersgerecht. Schlu?folgerung: Die Symptome Alkalose, respiratorische Insuffizienz und eine schnelle Verschlechterung des Allgemeinzustands bei Neugeborenen sollten an einen Harnstoffzyklusdefekt denken lassen. Medikament?se Therapie und die Kombination aus Peritoneal- und H?modiafiltration sind prim?r lebenserhaltend. Deutliche Residualsch?den sind die Regel, die überlebensprognose ist eingeschr?nkt. Na-Phenylbutyrat hat weniger Nebenwirkungen als Na-Benzoat. Therapiebeginn vor dem neonatalen Hirn?dem kann Komplikationen verhindern.      

Isolation of non-O1 Vibrio cholerae associated with enteric disease of herbivores in western Colorado.

Non-O1 Vibrio cholerae was isolated from a horse (Equus caballus), a lamb (genus Ovis), and two American buffalo (Bison bison) suffering from enteric disease in the western part of Colorado. In 1981, a foal died of apparent respiratory failure. Necropsy findings included heart failure and gastroenteritis. V. cholerae serovar 347 (Smith) was isolated from the colon of this animal. V. cholerae serovar 27 (Smith) was isolated in 1983 from the intestine of a feedlot lamb suffering from pneumonia and severe watery diarrhea. In 1984, an enteric disease occurred in a herd of American bison. The sick animals were depressed and separated from the herd, dying in about 3 days. Of approximately 100 adult bison, 7 died. Necropsy of one animal revealed that gross lesions were limited to the gastrointestinal tract. V. cholerae serovar 27 (Smith) was isolated from the abomasum, duodenum, and colon of this animal. A swab specimen from the intestine of another dead bison also yielded V. cholerae serovar 27 (Smith).     

CD4+ T-cell dynamics and host predisposition to infection.

Resistance to infection is often associated with proliferative T-cell responses corresponding to activation of the Th1 CD4+ T-cell subset, while the proliferative responses of chronically infected individuals are often limited. A mathematical model of the interaction between Th1 cells and a replicating pathogen has been used to demonstrate that antigen dose-dependent inhibition of Th1-cell proliferation may differentially predispose the host to resistance or chronic infection according to the level of exposure. Furthermore, the rapidity of pathogen turnover dramatically influences the qualitative relationship between exposure level and outcome, the temporal progression of infection, and the extent to which superimposed regulation of effector function (distinct from proliferation) will alter the predicted predisposition.     

pH Sensitivity of non-synaptic field bursts in the dentate gyrus

Under conditions of low [Ca(2+)](o) and high [K(+)](o), the rat dentate granule cell layer in vitro develops recurrent spontaneous prolonged field bursts that resemble an in vivo phenomenon called maximal dentate activation. To understand how pH changes in vivo might affect this phenomenon, the slices were exposed to different extracellular pH environments in vitro. The field bursts were highly sensitive to extracellular pH over the range 7.0-7.6 and were suppressed at low pH and enhanced at high pH. Granule cell resting membrane potential, action potentials, and postsynaptic potentials were not significantly altered by pH changes within the range that suppressed the bursts. The pH sensitivity of the bursts was not altered by pharmacologic blockade of N-methyl-D-aspartate (NMDA), non-NMDA, and GABA(A) receptors at concentrations of these agents sufficient to eliminate both spontaneous and evoked synaptic potentials. Gap junction patency is known to be sensitive to pH, and agents that block gap junctions, including octanol, oleamide, and carbenoxolone, blocked the prolonged field bursts in a manner similar to low pH. Perfusion with gap junction blockers or acidic pH suppressed field bursts but did not block spontaneous firing of single and multiple units, including burst firing. These data suggest that the pH sensitivity of seizures and epileptiform phenomena in vivo may be mediated in large part through mechanisms other than suppression of NMDA-mediated or other excitatory synaptic transmission. Alterations in electrotonic coupling via gap junctions, affecting field synchronization, may be one such process.