Water loss in aging and its clinical significance

Tissue water loss that occurs in aging has important implications for health status and treatment. This article discusses known mechanisms, physiologic examples, and clinical consequences of body-water changes with age, and suggests that careful monitoring of these changes can lead to better guiding of medication and fluid administration to avoid preventable complications.     

Hospital influences on early infant-feeding practices

Newborn nursery nursing staff members were surveyed to determine their attitudes and teaching practices regarding breast- and bottle-feeding. Concurrently, mothers using this nursery responded to a structured interview concerning their infant-feeding practices at 14 to 21 days postpartum and possible hospital influences on these practices. The nursing staff strongly advocated breast-feeding and did not favor specific bottle-feeding practices or products. Nursing staff counseling was generally interpreted by mothers as supporting breast-feeding, but this did not deter a large proportion of mothers who stated an initial preference for breast-feeding from introducing formula as a supplementary or exclusive form of infant feeding during the short study period. Almost all mothers doing any amount of bottle-feeding at the time of their interview were using the same formula brand and a ready-to-feed preparation used during their hospital stay. Other influences on mother's infant-feeding patterns are discussed. It is concluded that the hospital staff and routines exerted a stronger influence on mothers' infant-feeding practices by nonverbal teaching (the hospital "modeling" of infant formula products) than by verbal teaching (counseling supporting breast-feeding). Future studies might explore new ways of supporting mothers who desire to breast-feed by designing innovative hospital routines to model breast-feeding rather than feeding by infant formula.     

Breast mycobacterial infection in a haemodialysis patient.

Mycobacterial infection is relatively common among patients maintained on haemodialysis and may present in uncommon locations and acquire an unusual course. We present a patient in whom a breast mass was found to be caused by primary mycobacterial infection. This is to our knowledge the first report on breast mycobacterial infection in a haemodialysis patient.     

Predictors of single-gland vs multigland parathyroid disease in primary hyperparathyroidism: a simple and accurate scoring model

HYPOTHESIS: Preoperative clinical, biochemical, and imaging studies could be used to reliably select patients with single-gland primary hyperparathyroidism who could undergo minimally invasive parathyroidectomy and to determine whether additional perioperative testing is necessary. DESIGN: Retrospective analysis. SETTING: Tertiary referral center. PATIENTS: A total of 238 patients who underwent neck surgical exploration and parathyroidectomy for primary hyperparathyroidism from January 7, 2002, to December 23, 2004. MAIN OUTCOME MEASURES: Demographic, clinical, biochemical, and imaging factors that predict single-gland vs multigland parathyroid disease, and biochemical cure. RESULTS: Of the 238 patients, 75.2% had a single adenoma, 21.4% had asymmetric 4-gland hyperplasia, and 3.4% had double adenomas. A biochemical cure was achieved in 99.2% of the patients. Preoperative calcium and intact parathyroid hormone levels were significantly higher (P = .03 and .04, respectively) and ultrasound and sestamibi scan results were more likely to be positive (both P<.001) in single-gland primary hyperparathyroidism. A dichotomous scoring model based on preoperative total calcium level (>/=3 mmol/L [>/=12 mg/dL]), intact parathyroid hormone level (>/=2 times the upper limit of normal levels), positive ultrasound and sestamibi scan results for 1 enlarged gland, and concordant ultrasound and sestamibi scan findings reliably distinguished single-gland vs multigland cases (P<.001). The positive predictive value of this scoring model to correctly predict single-gland disease was 100% for a total score of 3 or higher. CONCLUSIONS: Preoperative biochemical and imaging study results reliably distinguished single-gland vs multigland parathyroid disease in primary hyperparathyroidism. Our findings suggest that patients with a score of 3 or higher can undergo a minimally invasive parathyroidectomy without the routine use of intraoperative parathyroid hormone or additional imaging studies, and those with a score of less than 3 should have additional testing to ensure that multigland disease is not overlooked.     

Quantitative studies of the effect of antagonists on the acute toxicity of organophosphates in rats

1. The subcutaneous acute toxicities of the vinyl phosphate pesticides monocrotophos, dicrotophos, chlorfenvinphos, crotoxyphos, dichlorvos, mevinphos, and of the experimental compounds SD 4455 (cis-2-carboxy-1-methylvinyl dimethylphosphate) and SD 7779 (cis-2-(1-phenylethoxy) carbonyl-1-methylvinyl diethylphosphate) have been determined in female rats.2. The effects on the log dose-probit mortality curves to the vinylphosphates of the therapeutic subcutaneous administration of methylatropine, atropine, N-methylpyridinium-2-aldoxime methanesulphonate and obidoxime have been studied.3. Elevation of the LD50 values by the therapeutic regimens was shown to be an unsatisfactory measure of therapeutic efficiency, while reduction of the effect of a maximally lethal dose (LD90) to less than that of a minimally lethal dose (LD10) provided a better quantitative measure of therapeutic efficiency.4. The combination of atropine sulphate (50 mumol base/kg) with obidoxime (250 mumol/kg) was found to be generally the most effective of the antidotal regimens.     

B lymphocyte stimulator expression in pediatric systemic lupus erythematosus and juvenile idiopathic arthritis patients

Objective

To assess the expression of B lymphocyte stimulator (BLyS) in patients with pediatric systemic lupus erythematosus (SLE) or juvenile idiopathic arthritis (JIA).

Methods

Blood samples collected from patients with pediatric SLE (n = 56) and patients with JIA (n = 54) at the beginning and end of a 6‐month interval were analyzed for plasma BLyS protein levels by enzyme‐linked immunosorbent assay and for blood leukocyte full‐length BLyS and ΔBLyS messenger RNA (mRNA) levels by quantitative real‐time polymerase chain reaction (normalized to 18S expression). Healthy siblings (n = 34) of these patients served as controls.

Results

In pediatric SLE, plasma BLyS protein and blood leukocyte BLyS mRNA levels were each significantly elevated, and plasma BLyS protein levels, but not blood leukocyte BLyS mRNA levels, were correlated with disease activity. In contrast, plasma BLyS protein levels were normal in JIA despite blood leukocyte BLyS mRNA levels being elevated to degrees similar to those in pediatric SLE. Among JIA patients, neither BLyS parameter was correlated with disease activity. In both pediatric SLE and JIA, the BLyS expression profiles remained stable at 6 months.

Conclusion

Our findings indicate that, as previously noted in adult SLE, plasma BLyS protein and blood leukocyte BLyS mRNA levels are elevated in pediatric SLE. The correlation of plasma BLyS protein levels with disease activity points to BLyS as a candidate therapeutic target in pediatric SLE. Contrary to previous observations in adults with rheumatoid arthritis, plasma BLyS protein levels are normal in JIA despite elevated blood leukocyte BLyS mRNA levels. The absence of correlation between either of the BLyS parameters and disease activity in JIA calls for circumspection prior to assigning BLyS as a candidate therapeutic target in this disorder.

     

Anakinra in the treatment of polyarticular-course juvenile rheumatoid arthritis: safety and preliminary efficacy results of a randomized multicenter study

This study assessed the safety and preliminary efficacy of the interleukin-1 receptor antagonist anakinra in patients with polyarticular-course juvenile rheumatoid arthritis (JRA). Eighty-six patients entered a 12-week open-label run-in phase (1 mg/kg anakinra daily, ≤100 mg/day). Fifty responders were randomized to anakinra or placebo in a 16-week blinded phase, followed by a 12-month open-label extension (N = 44). Due to low enrollment, the primary endpoint was changed from efficacy to safety. The incidence and nature of adverse events were similar across all study phases, with the exception of injection site reactions, which were mild to moderate and decreased with time. Anakinra produced a nonsignificant (P = 0.11) reduction in disease flares compared with placebo. When normalized to 1 mg/kg dose, anakinra plasma concentrations were similar to values in adult patients with rheumatoid arthritis. These results indicate that anakinra 1 mg/kg once daily (≤100 mg/day) is safe and well tolerated in patients with JRA.