Multiple dimensions of caring for a patient with acute necrotizing fasciitis.

Critical care nurses within acute care settings are responsible for providing healthcare to a wide variety of patients and, consequently, knowledge regarding how to care for a patient with acute necrotizing fasciitis is imperative. A case study is presented to evidence the need for a multidisciplinary approach. Necrotizing fasciitis is defined and treatment options are presented. Caring for this patient is very challenging and demands a multidisciplinary team to coordinate all aspects of care to promote better patient outcomes.     

Adult rat seminiferous tubules secrete a fraction greater than 30 kDa to regulate spermatogenesis

The present study was designed to examine the effects of a >30kDa fraction of medium conditioned for 2 days by adult rat seminiferoustubules on inhibin secretion by cultured tubules, and on spermatogenesisand fertility of male rats. Inhibin secretion was assayed byadding the >30 kDa fraction to 5 cm segments of adult ratseminiferous tubules and measuring inhibin by radioimmunoassayat 2 day intervals. Fertility was assayed by injecting malerats daily for up to 45 days with the >30 kDa fraction andthen mating them with a proestrus female, or by injecting for15 days and mating them with two female rats. The assay usedto evaluate the in-vivo effect of the >30 kDa fraction onthe testis involved an assessment of frequencies of seminiferoustubule stages scored by transillumination on intact tubules.The addition of the >30 kDa fraction to the adult rat seminiferoustubules cultured for 2 days resulted in an inhibition of inhibinsecretion into the medium. This effect was reversed when thefraction was removed and changed with fresh medium and culturedfor a further 4 days. The >30 kDa fraction administered i.p.to adult male rats resulted in a low fertilization rate comparedto control rats (67%) (P < 0.05). The assessment of frequenciesof seminiferous tubule stages scored by transillumination showedan increased frequency of stage VI and decreased frequency ofstages VII and VIII after treatment. The results of the presentstudy provide additional evidence that local regulation of Sertolicell function is mediated by a >30 kDa component or componentssecreted by adult seminiferous tubules which could arrest spermatogenesis.     

Neuroimaging in Pineal Tumors

BACKGROUND AND PURPOSE: The authors report radiological findings in 11 tumors in the pineal region, which were histologically diagnosed as germinomas, pineocytomas pineoblastomas, ependymomas, teratomas, and astrocytomas. METHODS: Computed tomography (CT) was performed in seven patients and magnetic resonance imaging (MRI) was performed in all patients. RESULTS: CT showed a solid or solid/cystic mass with variable contrast enhancement. MRI showed a heterogeneous mass, with hypointense signal on T1 and iso/hyperintense signal on T2-weighted images (WI) and gadolinium enhancement. Extension to adjacent structures occurred in five patients and spread through the cerebral spinal fluid (CSF) in two. CONCLUSIONS: Pineal region tumors have no pathognomonic imaging pattern. MRI and CT are complementary in diagnosis and are important to determine localization, extension, and meningeal spread.     

DNA analysis of HLA-DR, DQ and DP genes in pauciarticular juvenile rheumatoid arthritis.

HLA-DR, DQ, and DP alleles were determined by restriction fragment length polymorphism (RFLP) and oligonucleotide hybridization analysis in 50 Caucasian children with pauciarticular juvenile rheumatoid arthritis (PaJRA) and 82 controls. There was an increased frequency of DR5, DRw8, and DQw4, as well as individual DQ alpha and beta chains, DQA*0401 and DQB1*0402, respectively, in this group of patients. There was an absolute association between DRw8, DQw4, DQA1*0401, and DQB1*0402 in the patient population. HLA-DPw2.1 was also increased in frequency. There was little evidence of linkage disequilibrium found between DPw2.1 and DR5, DRw8, or DQw4. These MHC Class II associations were more characteristic of those patients with young age of onset (less than 5 years), rather than those with onset greater than or equal to 5 years of age. Our data confirmed the previous associations of HLA-DR5, DRw8, and DPw2.1 with PaJRA and suggested a new association for DQ alpha and beta genes in the clinical expression of this disease.     

Blood coagulation, fibrinolytic and inhibitory profiles in renal transplant recipients: comparison of cyclosporine and azathioprine.

Renal transplant recipients treated with cyclosporine (CS) have been reported to be at increased risk of thrombotic complications. The present study was intended to examine the blood coagulation, fibrinolytic, and inhibitory systems in such patients. Eight transplant recipients on maintenance immunosuppression with CS and prednisone were studied. Five transplant recipients maintained on azathioprine (AZA) and prednisone and 32 normal volunteers served as controls. Plasma antigen concentrations and/or activities of various proteins in the above pathways were measured. Both the CS and AZA groups exhibited significant elevations of factor IX activity, von Willebrand factor (vWF), D-dimer, protein C and tissue type plasminogen activator (t-PA) levels when compared with the normal controls. In addition, CS group showed a significant elevation of alpha 2-macroglobulin activity and AZA group showed a significant reduction in factor XII activity when compared with the normal controls. Comparison of data from CS and AZA groups revealed higher factor XII activity and vWF concentration in the former group. In conclusion, transplant recipients treated with long-term cyclosporine and prednisone exhibited significant elevation of plasma vWF, D-dimer and protein C concentrations. In addition, both CS and AZA-treated transplant recipients showed increased plasma concentrations of D-dimer and t-PA. The latter observations suggest in vivo thrombin generation, fibrin formation and degradation.     

A review of the effects of expansion of the nasal base on nasal airflow and resistance.

PURPOSE: The purpose of this article is to inform the reader of the current literature regarding nasal airflow resistance. The anatomy and physiology of nasal airflow resistance will be examined and the known effects of widening of the nasal airway upon airflow will be described. MATERIALS AND METHODS: This article is a review of the current literature regarding nasal airflow and resistance and the effects of widening of the nasal base. No patient data were collected. RESULTS: The literature shows that nasal airflow resistance can be changed by surgical manipulation and by rapid palatal expansion, but that the effects on airflow resistance and future growth and development are unpredictable. CONCLUSION: Patients with a maxilla that is constricted in the transverse dimension and nasal airflow problems may benefit from expansion of the nasal base. The resultant effects upon nasal airflow resistance and subsequent growth and development are unpredictable and therefore airflow issues alone may not be a primary reason to increase the transverse dimension of the nasal base.     

Effects of polyethylene on macrophages

A system was developed to expose macrophages to polyethylene in vitro. Exposure of macrophages to these particles in isolation led to the release of tumor necrosis factor alpha and prostaglandin E₂. Exposure of macrophages in co-culture with osteoblasts to polyethylene particles increased the release of prostaglandin E₂ and also led to the release of interleukin-6. Incubation of radiolabelled calvariae with conditioned medium from macrophages exposed to polyethylene particles alone or to particles in co-culture with osteoblasts led to bone resorption reflected by release of ⁴⁵Ca. Incubation with pamidronate was effective in inhibiting resorption stimulated by conditioned medium from macrophages exposed to these particles alone or in co-culture with osteoblasts. This demonstrates that pamidronate, or other bisphosphonates, may be effective in inhibiting bone resorption at the implant/bone interface in association with the macrophage ressponse to particulate polyethylene. Further investigation into the possible use of pamidronate or other bisphosphonates in the treatment of aseptic loosening is warranted.     

Leucocyte populations in semen and male accessory gland function: relationship with antisperm antibodies and seminal quality

Semen samples from 279 infertility patients attending an Immunological Centre were analysed to evaluate the relationship between the populations of leucocytes, seminal quality, antisperm antibodies, and seminal vesicle function. The most frequent finding between leucocytospermic samples was asthenozoospermia (57%), whereas in non-leucocytospermic samples normozoospermia was the most frequent finding (47%). In the samples with asthenozoospermia, granulocytes predominated, whereas in those with oligozoospermia and azoospermia a reduction in the number of macrophages and lymphocytes was observed, suggesting an obstructive process at the level of epididymis and/or vas deferens where these leucocytes are mostly produced. In the case of hypofunction of the seminal vesicles there was a predominance in granulocytes. The increased levels of each type of leucocytes affected seminal quality only when seminal vesicles were affected. Only the elevated granulocytes count was related to a decrease in sperm motility. In those samples with leucocytospermia, positive antisperm antibodies (ASA) were associated with low sperm motility, low sperm normal morphology, and low value of seminal corrected fructose, whereas, in the absence of leucocytospermia, ASA, were more related to low sperm counts. These data suggest that granulocytes were more related to seminal vesicles dysfunction and sperm motility changes, and that ASA may be observed in the presence or absence of leucocytospermia.     

Measurement of thorium isotopes and 228Ra in soft tissues and bones of a deceased Thorotrast patient.

The whole body of an individual injected with Thorotrast 36 y prior to her death was analyzed for 232Th, 228Ra, 228Th, and 230Th. Measurement of these isotopes in all tissues of the body will provide data necessary to caculate the radiation dose to individual tissues and to evaluate the risk potential associated with deposition of thorium and progeny in humans. The tissues were ashed, dissolved in acid, and the thorium isolated by ion exchange and electrodeposition. The 228Ra was determined by measuring the 0.991-MeV gamma rays associated with decay of the 228Ac daughter. It was estimated that almost all of the 232Th from the original injection was retained in the body, mostly in the tissues of the reticuloendothelial system. A total of 28 kBq (0.76 microCi) of 232Th was measured in the soft tissues and bones. The body also contained 13 kBq 228Ra, 12 kBq 228Th, and 3.9 kBq 230Th. A Thorotrastoma contained about 3.5% of the total activity. Excluding the Thorotrastoma, approximately 45% of all the activity (232Th, 228Ra, 228Th, and 230Th) was retained in the liver, 13% in the spleen, 2% in muscle, 1% in skin, slightly less than 1% in the respiratory tract, 4% in all other soft tissues, and 33% in the skeleton (bone and bone marrow). Sixty to 80% of the thorium activity in bones containing red marrow was located in the marrow. Bones containing yellow marrow had less than 40% of the thorium activity in the marrow. Highest concentrations were found in the hepatic and other abdominal lymph nodes, spleen, hilar lymph nodes, liver, trachea, and bone. Approximately 60% of the 228Ra formed from the decay of the 232Th had been excreted from the body. The 228Ra and 228Th were in approximate equilibrium throughout the body.