Renal Kallikrein Excretion in Alcoholic Cirrhosis

Severe liver disease is often associated with renal hemodynamic changes, and these changes may involve vasoactive hormones. The vasodilatory renal kallikrein-kinin system has received little previous study in these patients. We measured urinary kallikrein in nine patients with alcoholic cirrhosis under rigid metabolic conditions and simultaneously evaluated renin, aldosterone and urinary prostaglandins. Plasma renin und aldosterone were generally increased as expected but urinary kallikrein was surprisingly diminished (13.3 ± 3.7 vs. 38.8 ± 11.1 SE, E.U./day. P < 0.05). despite adequate creatinine clearance (81 ± 9 ml./min.). Administration of prostaglandin inhibitors reduced urinary prostaglandin E by 72% and creatinine clearance by 56% but did not alter urinary kallikrein. Mineralocor-ticoid inhibition by spironolactone induced a natriuresis in four patients with ascites (from 1.4–140 mEq. Na⁺/day) but also failed to alter kallikrein. Thus, kallikrein excretion is paradoxically reduced and seemingly unresponsive to alterations in the prostaglandin and renin-aldosterone systems. If urinary kallikrein quantitatively reflects intrarenal kallikrein-kinin activity, the impairment in this vasodilatory system may mediate the altered renal hemodynamics of severe liver disease.     

Writing for publication

Writing for publication is rewarding; it requires specific skills which are identified and explored in this article. Intending authors are encouraged to be systematic in targeting the audience, prepararing the text, and presenting it to a publisher. The differing styles needed for academic articles, book reviews and letters are explored as are the stages in publication.     

Is fecundability associated with month of birth? An analysis of 19th and early 20th century family reconstitution data from The Netherlands

The relationship between fecundability and month of birth was investigated in a cohort of 1526 women who married between 1802 and 1929, using only women whose first marriage occurred before the age of 35 years. On the basis of their time to pregnancy (TTP, calculated as time between wedding and first birth minus gestational length), women were categorized into two groups: fecunds (TTP up to 12 months or prenuptial conceptions, n = 1348) and subfecunds (TTP >18 months, n = 118). By use of logistic regression, cosinor functions with a period of 1 year or 6 months and variable shift and amplitude were fitted through the monthly odds of subfecunds versus fecunds. The best fitting curve was unimodal, with a zenith in September (P = 0.13 for H0: no differences). Exclusion of childless women (n = 36, minimum follow-up 5 years) from the subfecunds led to a similar curve (P < 0.01), while childless women, as compared with fecunds, showed a birth distribution that was best represented with a bimodal curve with zeniths in January and July (P = 0.06). This study provides evidence for the existence of differences in fecundability by month of birth. The cause of this relationship is unclear, but may lie in a melatonin-dependent circannual variability of the quality of the oocyte.      

Medicinal therapy for hearing loss resulting from noise exposure

A large-scale review of the literature concerning the effects of noise on hearing, published primarily during the 1970s, was initiated by the National Institute of Neurological and Communicative Disorders and Stroke in 1981. This review demonstrated a continuing search for medicinal treatment for the adverse effects of noise on hearing. The present article focuses on the results of investigations of human subjects. The literature in this area is primarily European and deals principally with treatment of acoustic trauma, although a few reports have described attempts to render the ear less susceptible to the hazards of chronic noise exposure. Much of the published information is of questionable value because of inadequate experimental design and control. To date, the search for effective medicinal treatment for hearing loss caused by noise has been unsuccessful. Results reported from studies of the effects of carbogen are encouraging and suggest that continued rigorous investigation of this agent is warranted.     

Laryngeal aerodynamics associated with selected voice disorders

Measures of estimated subglottal air pressure and laryngeal air flow during speech production are compared for adults with normal laryngeal function and those with laryngeal abnormalities. The most traditional measure, air flow during sustained vowel production, is not a strong predictor of laryngeal function during speech production. Subglottal air pressure and laryngeal air flow offer insight into voice disorders and provide directions for therapy as well as a method for the quantitative assessment of treatment outcomes.     

Prevalence and aetiology of neurological impairment in extremely low birthweight infants

Objective : To determine the prevalence and perinatal predictors of cerebral palsy, intellectual impairment, visual impairment and deafness in a cohort of extremely low birthweight (ELBW) infants at two years of age.
Methodology : The study population comprised 199 of the 224 (89%) ELBW infants managed at the Mater's Mothers Hospital, Brisbane, between July 1977 and February 1990 and who survived to two years. The prevalence of cerebral palsy, intellectual impairment, blindness and deafness was measured by clinical, psychometric and audiological assessment and the association with 24 risk factors examined.
Results : Cerebral palsy occurred in 20 children (10%). Risk of cerebral palsy was associated with ventricular dilatation, intraventricular haemorrhage, necrotizing enterocolitis and multiple birth, though only ventricular dilatation (OR 4.41; 95% Cl 1.32-14.8) remained significant in the adjusted analysis. Intellectual impairment occurred in 20 children (10%) and was independently associated with ventricular dilatation (OR 15.0; 95% Cl 2.2-102.8), ventilation F _iO₂ >80% (OR 3.4; 95% Cl 1.01-11.5), vaginal delivery (OR 3.5; 95% Cl 1.09-11.4) and male sex (OR 6.1; 95% Cl 1.67-22.3). No perinatal predictor was statistically associated with risk of deafness. Retinopathy of prematurity (OR 36.9; 95% Cl 2.8-495.5) was associated with risk of later visual impairment.
Conclusions : Intellectual impairment was associated with a broad range of perinatal variables. Cerebral palsy was associated with fewer variables, all of which were also associated with intellectual impairment. Neurologic injury was associated with male sex and multiple birth, which are not biological insults themselves, but may be markers of susceptibility to injury.     

Protein nutrition, faecal flora and iron metabolism: the role of milk-based formulae

This paper explores the role of milk-based formulae in achieving four aspects of nutritional health in infants and toddlers: in the suckling, to mimic the amino acid metabolism and the faecal flora of a breast-fed baby; in the weanling, to achieve adequate protein intakes in later infancy and beyond and to achieve satisfactory haemoglobin concentrations in the early toddler years. Milk-based formulae have two roles in infant nutrition: as so-called breast milk substitutes and as a safety net during the weaning period; the latter role may be the more important.