Active sodium transport across the epithelium of the human kidney pelvis. Part 1

To clarify whether the epithelium of the human urinary tract possesses an active transepithelial sodium transport, the unidirectional sodium fluxes and the electrical parameters of the epithelium were determined on isolated pieces of renal pelvis. The epithelium was incubated in isotonic Ringer's solution at 37.3C in Ussing-type chambers. The transepithelial potential difference was found to be 15.8 +/- 3.0 mV and the transepithelial electrical resistance 760 +/- 48 omega . cm.-2. The transepithelial, unidirectional sodium fluxes were measured under short-circuit conditions. From both the unidirectional sodium influx from the luminal to the serosal side (7.01 +/- 2.17) and from the efflux in the opposite direction (0.45 +/- 0.07) a transepithelial sodium net flux of 6.56 +/- 2.20 nmol. . minutes-1. cm.-2 was calculated. Since there are no passive forces across the epithelium under short circuited conditions to explain the net flux, an active sodium transport has to be postulated. In all experiments, the simultaneously measured short circuit current (6.43 +/- 2.18 nmol. . minutes-1 . cm-2) was not significantly different from the net sodium flux, and can therefore be taken as a measure of the net flux.     

A cost analysis of the first year after stroke - early triage and inpatient rehabilitation may reduce long term costs

AIM OF THE STUDY: To analyse the costs of stroke in the first year covered by insurance companies and to correlate them with the clinical outcome data. METHODS: We contacted the insurance companies of 172 consecutive stroke patients of a single institution cohort for a detailed report of the stroke costs. A complete data set over one year was obtained from 131 patients (76%). RESULTS: Severity of stroke was significantly associated with increasing total costs (p = 0.0002). The rehabilitation clinic made up 37% of the total costs followed by nursing home with 21% and acute hospital with 21%. Mean cost of stroke per patient was 31,115 CHF in the first year. Costs per patient for inpatient rehabilitation were similar to those for the nursing home after one year; however, the Barthel-index of patients with inpatient rehabilitation increased by 42 +/- 29 points as compared to patients without inpatient rehabilitation by 23 +/- 26 points (p <0.05), and 86% resp. 81% of patients with inpatient stroke rehabilitation lived independently after 6 and 12 months respectively. CONCLUSIONS: The high level of independence after inpatient stroke rehabilitation underlines the importance of patient selection and/or rehabilitation. Therefore, long-term stroke costs may be significantly reduced by an early and careful triage in the case management after stroke and a case-dependent investment in initial costly appearing inpatient rehabilitation.     

A multicentre, prospective study to evaluate costs of septic patients in Brazilian intensive care units

BACKGROUND: Sepsis has a high prevalence within intensive care units, with elevated rates of morbidity and mortality, and high costs. Data on sepsis costs are scarce in the literature, and in developing countries such as Brazil these data are largely unavailable. OBJECTIVES: To assess the standard direct costs of sepsis management in Brazilian intensive care units (ICUs) and to disclose factors that could affect those costs. METHODS: This multicentre observational cohort study was conducted in adult septic patients admitted to 21 mixed ICUs of private and public hospitals in Brazil from 1 October 2003 to 30 March 2004. Complete data for all patients admitted to the ICUs were obtained until their discharge or death. We collected only direct healthcare-related costs, defined as all costs related to the ICU stay.Enrolled patients were assessed daily in terms of cost-related expenditures such as hospital fees, operating room fees, gas therapy, physiotherapy, blood components transfusion, medications, renal replacement therapy, laboratory analysis and imaging. Standard unit costs (year 2006 values) were based on the Brazilian Medical Association (AMB) price index for medical procedures and the BRASINDICE price index for medications, solutions and hospital consumables. Medical resource utilization was also assessed daily using the Therapeutic Intervention Scoring System (TISS-28). Indirect costs were not included. RESULTS: With a mean (standard deviation [SD]) age of 61.1 +/- 19.2 years, 524 septic patients from 21 centres were included in this study. The overall hospital mortality rate was 43.8%, the mean Acute Physiology And Chronic Health Evaluation II (APACHE II) score was 22.3 +/- 5.4, and the mean Sequential Organ Failure Assessment (SOFA) score at ICU admission was 7.5 +/- 3.9.The median total cost of sepsis was $US 9632 (interquartile range [IQR] 4583-18 387; 95% CI 8657, 10 672) per patient, while the median daily ICU cost per patient was $US 934 (IQR 735-1170; 95% CI 897, 963). The median daily ICU cost per patient was significantly higher in non-survivors than in survivors, i.e. $US 1094 (IQR 888-1341; 95% CI 1058, 1157) and $US 826 (IQR 668-982; 95% CI 786, 854), respectively (p < 0.001). For patients admitted to public and private hospitals, we found a median SOFA score at ICU admission of 7.5 and 7.1, respectively (p = 0.02), and the mortality rate was 49.1% and 36.7%, respectively (p = 0.006). Patients admitted to public and private hospitals had a similar length of stay of 10 (IQR 5-19) days versus 9 (IQR 4-16) days (p = 0.091), and the median total direct costs for public ($US 9773; IQR 4643-19 221; 95% CI 8503, 10 818) versus private ($US 9490; IQR 4305-17 034; 95% CI 7610, 11 292) hospitals did not differ significantly (p = 0.37). CONCLUSIONS: The present study provides the first economic analysis of direct costs of sepsis in Brazilian ICUs and reveals that the cost of sepsis treatment is high. Despite similar ICU management, there was a significant difference regarding patient outcome between private and public hospitals. Finally, the median daily costs of non-survivor patients were higher than survivors during ICU stay.     

Clinical and histologic characteristics of normal gingiva in dogs

The aims of the present study were to establish normal gingiva in dogs, to characterize the clinical conditions prevailing and to stereologically describe the structural composition of the normal gingival tissues. Three beagle dogs were subjected to regular oral hygiene procedures during 15 weeks. Measurements of gingival fluid flow and the amounts of crevicular leukocytes served to clinically assess the gingival conditions. Semi-and ultrathin sections from biopsies of normal buccal gingival tissues from premolars were subjected to stereologic analysis based on morphometric point counting procedures. Gingival normality was achieved in two of the dogs. The normal gingival tissue in these dogs was characterized clinically by abscense of gingival fluid flow and by a minute amount of crevicular leukocytes. A gingival sulcus was most often absent. The junctional epithelium was without rete pegs, and the entire gingival connective tissue was densely filled by homogeneous collagen fiber bundles. A few isolated inflammatory cells were present in the junctional epithelium and the adjacent connective tissue. No clusters of inflammatory cells forming an infiltrate could be observed.
Stereologically, the gingival tissue comprised 48% epithelium and 52% connective tissue. The junctional epithelium occupied 10% of the gingival tissue and included a fraction of 2.8% occupied by leukocytes. The latter by volume comprised 50% neutrophilic granulocytes and mononuclear cells each. The connective tissue was composed of 67% collagen fibers, 14% free cells and 19% residual tissue. The composition of the connective tissue adjacent to the junctional epithelium differed somewhat from that of more central connective tissue fractions.     

Sentinel-Lymphknoten bei gynäkologischen Malignomen

Background

The concept of sentinel removal is a safe procedure in the field of gynecological oncology and is an integral part of staging in early vulvar and cervical cancer. Moreover resent studies have shown that this type of nodal staging has promising results even in endometrial cancer. Only in ovarian cancer is this concept still far from clinical routine.

Diagnosis

There are at least three different tracers for staining the lymph nodes: blue dye, indocyanine green, and radioactive technetium. The blue tracer is visualized with conventional cameras, while indocyanine green needs a special fluorescent camera. Technetium is detectable only with a special probe and an acoustic signal in the proximity of a stained lymph node.

Conclusion

The increasing data available in the field of sentinel node technology shows that this concept will be used in an ever broader area in the future—with the same oncological safety but with lower peri- and postoperative morbidity.

     

MPL mutations in myeloproliferative disorders: analysis of the PT-1 cohort

Activating mutations of MPL exon 10 have been described in a minority of patients with idiopathic myelofibrosis (IMF) or essential thrombocythemia (ET), but their prevalence and clinical significance are unclear. Here we demonstrate that MPL mutations outside exon 10 are uncommon in platelet cDNA and identify 4 different exon 10 mutations in granulocyte DNA from a retrospective cohort of 200 patients with ET or IMF. Allele-specific polymerase chain reaction was then used to genotype 776 samples from patients with ET entered into the PT-1 studies. MPL mutations were identified in 8.5% of JAK2 V617F^– patients and a single V617F⁺ patient. Patients carrying the W515K allele had a significantly higher allele burden than did those with the W515L allele, suggesting a functional difference between the 2 variants. Compared with V617F⁺ ET patients, those with MPL mutations displayed lower hemoglobin and higher platelet levels at diagnosis, higher serum erythropoietin levels, endogenous megakaryocytic but not erythroid colony growth, and reduced bone marrow erythroid and overall cellularity. Compared with V617F^– patients, those with MPL mutations were older with reduced bone marrow cellularity but could not be identified as a discrete clinicopathologic subgroup. MPL mutations lacked prognostic significance with respect to thrombosis, major hemorrhage, myelofibrotic transformation or survival.     

Significantly shorter telomeres in T-cells of patients with ZAP-70+/CD38+ chronic lymphocytic leukaemia

In contrast to other B-cell neoplasias, chronic lymphocytic leukaemia (CLL) is characterized by increased non-leukaemic T-cells. In order to assess their replicative history, telomere length was analyzed in subsets of leucocytes from CLL patients. Naive and memory T-cells from ZAP-70(+)/CD38(+) patients exhibited significantly shorter average telomere lengths than ZAP-70(-)/CD38(-) patients. Compared to the age-related percentiles of telomere length values from healthy individuals practically all values of the naive and memory T-cells from the ZAP-70(+)/CD38(+) CLL patients fell below the 50th percentile. This indicated an extensive expansion and a role for T-cells in ZAP-70(+)/CD38(+) CLL patients.     

Imaging pediatric gastrointestinal stromal tumor (GIST)

Background

Gastrointestinal stromal tumors (GIST) are extremely rare in children. Imaging plays a key role in staging and monitoring therapy (surgical and with tyrosine kinase inhibitors). The vast majority of articles addressing imaging of GIST base on adults and are based on CT. The subtype “pediatric GIST” – if at all – is only mentioned in a dependent clause. Although the imaging features in children and adults are similar, histology, clinical course and thus imaging approach are different.