Acute renal failure needing dialysis in the intensive care unit and prognostic scores

BACKGROUND: Generic prognostic scores used in acute renal failure (ARF) give imprecise results; disease-specific indices applied to distinct populations or intensive care practices becomes inaccurate. The current study evaluates the adequacy of prognostic scores, in patients with severe ARF needing dialysis. METHODS: Known generic (APACHE II) and disease-specific (ATN-ISS) indices were applied to a cohort (n = 280) with ARF needing dialysis, under intensive care. Possible risk factors as causal factors, organ dysfunctions and clinical variables were examined, and a local index assembled by multivariate logistic regression analysis. Area under the receiver operating characteristics (ROC) curves evaluated the indices discriminating capacity. Goodness-of-fit testing and linear regression analysis appraised calibration. Validation was accomplished by the bootstrapping technique. The end-point was hospital mortality. RESULTS: Overall mortality was 85%. Female gender < 44 years (OR: 0.29; 95% CI: 0.10-0.84), liver/obstructive biliary disease (OR: 6.03; 95% CI: 1.65-22.08), being conscious (OR: 0.49; 95% CI: 0.21-1.14), use of vasoactive drug (OR: 3.13; 95% CI: 1.25-7.83), respiratory dysfunction (OR: 5.20; 95% CI: 1.25-7.83) or sepsis (OR: 2.62; 95% CI: 1.14-6.02) were associated with outcome. Areas under the ROC curve of 0.815, 0.652 and 0.814; Goodness-of-fit test P = 0.593, P < 0.001 and P = 0.002; and linear regression R2 = 0.973, R2 = 0.526 and R2 = 0.919 for the local index, APACHE II and ATN-ISS, respectively, indicate better performance by the local index. The local index median area under the ROC curve, by bootstrapping, was 0.820 (95% CI: 0.741-0.907). CONCLUSIONS: APACHE II score was inaccurate, and ATN-ISS poorly calibrated. When mortality or intensive care practices significantly deviate, local scores may better evaluate prognosis in severe ARF.     

An integrative approach to the neurophysiological substrates of social withdrawal and aggression

An integrative model of the neurophysiology of aggression and social withdrawal is proposed. A detailed overview of the limbic-hypothalamic-pituitary-adrenal (LHPA) axis is presented first, because we consider it to be a critical system that interacts with a variety of physiological processes to modulate affect-related behaviors. This detailed analysis of the LHPA axis is then used to clarify the research literature that links aggression and social withdrawal to LHPA functioning. We then review the role of amygdala and prefrontal cortex functioning in modulating aggression and social withdrawal. Particular attention is paid to how the amygdala and the prefrontal cortex interact with the LHPA system and the environment to produce specific behavioral tendencies throughout development. A brief overview of the implied methodological and theoretical model is provided. We explain how a detailed understanding of specific physiological processes is essential in order to develop appropriate research protocols. In addition, we suggest that future research should focus on the mapping of distinct integrative biosocial profiles that are related to specific behaviors during different developmental stages.     

History of abortion,preterm, term birth,and risk of preeclampsia: a population-based study

OBJECTIVE: The objective of this study was to examine the effect of previous abortion and preterm and term birth on the incidence of preeclampsia in subsequent pregnancies. STUDY DESIGN: A population-based retrospective cohort study was conducted that was based on 140,773 pregnancies that had delivered between 1993 and 1999 in 49 hospitals in Northern and Central Alberta, Canada. Multivariate logistic regression was applied to estimate odds ratios, with 95% confidence intervals, and to control for confounding variables. RESULTS: No significant difference was found in the incidence of preeclampsia in nulliparous women with previous abortion (2.6%) as compared to nulliparous women without previous abortion (2.9%; adjusted odds ratio, 0.89; 95% confidence interval, 0.78-1.01; P >.05). A single previous abortion was associated with a slightly decreased risk of preeclampsia (adjusted odds ratio, 0.84; 95% confidence interval, 0.72-0.97; P <.05). However, 2 and > or =3 abortions were not associated with a decreased risk of preeclampsia. In women with no history of previous abortion and term pregnancy, there was no significant difference in incidence of preeclampsia between women who had previous preterm birth (2.7%) and primigravid women (2.8%; adjusted odds ratio, 0.71; 95% confidence ratio, 0.48-1.03; P >.05). However, > or =2 previous preterm births were associated with a decreased risk of preeclampsia (adjusted odds ratio, 0.28; 95% confidence interval, 0.09-0.84; P <.01). The incidence of preeclampsia was markedly lower in multiparous women who previously delivered at term (0.9%) as compared to the incidence in primigravida women (2.9%; adjusted odds ratio, 0.29; 95% confidence interval, 0.26-0.33; P <.001). The adjusted odds ratios of preeclampsia for women with 1, 2, 3, and > or =4 previous term pregnancies were 0.32 (95% confidence interval, 0.28-0.36), 0.27 (95% confidence interval, 0.22-0.34), 0.22 (95% confidence interval, 0.15-0.33), and 0.21 (95% confidence interval, 0.12-0.35), respectively. CONCLUSION: A history of term pregnancy (> or =37 weeks) conveys a substantial "protection" against preeclampsia in the subsequent pregnancy.     

Melanocytic colonization of a meningothelial meningioma: histopathological and ultrastructural findings with immunohistochemical and genetic correlation: case report

OBJECTIVE AND IMPORTANCE: Melanocytic colonization of nonpigmented extracranial tumors has been reported in adenocarcinomas, squamous cell carcinomas, skin appendage tumors, and dermatofibrosarcoma protuberans. To our knowledge, melanocytic colonization of a meningioma has not previously been described. CLINICAL PRESENTATION: We report an unusual case of a 70-year-old African-American woman who presented with a large frontoparietal meningioma that extended through the calvarium. INTERVENTION: Craniotomy with gross total resection of the tumor was performed. Histochemistry, immunocytochemistry, ultrastructural analysis, and molecular genetic study via fluorescence in situ hybridization confirmed melanocytic colonization of a meningothelial meningioma. CONCLUSION: With the inclusion of meningothelial meningioma, the spectrum of tumors affected by melanocytic colonization continues to expand.     

Peyronie's disease: a review

PURPOSE: We provide a current review of Peyronie's disease. MATERIALS AND METHODS: We reviewed the world peer reviewed literature on the pathology, pathogenesis, diagnosis and treatment of Peyronie's disease. RESULTS: The incidence of Peyronie's disease has continuously increased during the last 30 years. However, fewer patients need prosthesis surgery as the sole treatment option because of earlier diagnosis, improved medical therapy, refinement in surgical technique and better understanding of the basic sciences of the disease. CONCLUSIONS: Currently patients with Peyronie's disease have had improvements in prognosis and experienced an expansion of the available therapeutic options.