Dentistry, neurology and nephrology--what is the connection?

Case report A 28-year-old female patient was admitted because of painlessmacroscopic haematuria. Past history included severe mentalretardation and nystagmus. At age 17, a computed tomography(CT) scan of the brain showed an absent cerebellar vermis andcerebellar hypoplasia. There was no     

Bicycle helmet use by adults: the impact of companionship.

Most of the nearly 1,000 fatal bicycle-related injuries annually could be prevented if riders used safety helmets. Helmet use by adult bicyclists has received relatively little attention because educational campaigns to promote helmet use generally focus on children. Helmet use by adult and child bicyclists at 120 suburban and rural sites in three Maryland counties was observed on two Saturdays in 1990-91 during an evaluation of the impact of a mandatory helmet law. Concordance or discordance of helmet use within various groups of bicyclists--adults only, adults with children, and children only--was recorded. Helmet use among 2,068 adult bicyclists was 49 percent, 51 percent, and 74 percent in the three counties. In two counties combined, 52 percent (365 of 706) of solo adult bicyclists wore helmets compared with only 5 percent (5 of 94) of solo child bicyclists (P < .001). Helmet use or nonuse was concordant among 87 percent of 277 adult-adult pairs, 94 percent of 50 child-child pairs, and 91 percent of 32 adult-child pairs of bicyclists observed. Concordance rates of helmet use or nonuse were similarly high among pairs of adult bicyclists of the same or mixed sexes. These data are consistent with the concept that both adults and children tend to adopt the helmet-wearing behaviors of their companions. Public health efforts focused on adults should encourage helmet use by adult bicyclists both to prevent head injuries and to provide a role model for children.     

A cluster of unexplained deaths in a nursing home in Florida.

In the two-week period November 13-27, 1984, 12 patients died in a 54-bed nursing home in Florida; based on previous mortality patterns, 2.5 deaths would have been expected for the whole month. There was no similar increase in deaths in November 1984 and no comparable monthly death rate for any of 69 nursing homes in the same county from 1976-84. Comparison of the 12 deaths in November with 28 deaths that occurred during the previous 10 months and with 31 surviving patients who were continuously present in the nursing home between November 12-28, 1984 revealed that the patients who died in November were more likely to have had onset of the terminal event during the night shift, had a recent visitor, and had an admitting diagnosis of organic brain syndrome. The abrupt increase in the death rate for November 1984 was not associated with a measurable change in population characteristics, an outbreak of infectious disease, or changes in procedures or the environment. Reviews of employee schedules revealed a consistent and strong association between the duty times of two nurses and the onsets of the terminal episode and the times of patient deaths. Continuing epidemiologic surveillance of adverse outcomes in nursing homes is recommended.     

Prospective comparison of plain abdominal radiography with conventional and digital renal tomography in assessing renal extracorporeal shock wave lithotripsy patients

Most publications citing the effectiveness of renal extracorporeal shock wave lithotripsy have used plain abdominal radiography to assess residual calculi after treatment. We compared radiologist sensitivity and specificity in the detection of calculi on plain abdominal radiographs versus conventional film-screen and digital renal tomograms in extracorporeal shock wave lithotripsy patients. Of the patients 50 were imaged before and within 24 hours after lithotripsy. Six radiologists evaluated the resultant 300 studies for the presence and location of calculi. The mean sensitivity for digital tomograms was 83% for pre-lithotripsy and post-lithotripsy studies, which was significantly higher than for plain abdominal radiography and conventional tomography after lithotripsy. However, there were significantly more false positive stone diagnoses associated with digital tomogram interpretation. Signal detection analysis verified the over-all superiority of digital tomography for post-extracorporeal shock wave lithotripsy imaging. Calculus detection by conventional and digital tomography is superior to detection by plain abdominal radiography. However, because we did not perform delayed imaging, it is not possible to say what impact digital tomography might have on the management of extracorporeal shock wave lithotripsy patients.     

Infectious complications of intrauterine insemination: a case report and literature review.

Intrauterine insemination is commonly performed in the treatment of infertility. Infectious complications associated with intrauterine insemination are frequently cited, though rarely reported. A review of the literature yields only five reported cases of pelvic infections subsequent to intrauterine insemination (IUI), and only two of these show firm evidence of infection, with none presenting bacteriologic confirmation. We report a case of Escherichia coli septicemia subsequent to an IUI performed on a patient with a large adenomyoma. Of 147 patients treated with IUI at Georgetown University from November 1987 through March 1990, this was the only infectious complication. The incidence of infectious complications in our series is thus 0.0068 (6.8 per 1,000 women). A review of infectious complications in 38 reported series on intrauterine inseminations reveals five infections in 3,129 patients. With the addition of our series to the literature, the prevalence of infectious complications is 1.83 per 1,000 women undergoing IUI. The rates were not significantly altered by semen washing with antibiotics, or the administration of prophylactic antibiotics to the woman (P = .81). We conclude that (1) the infection rate following IUI is small, (2) many of the infections subsequent to insemination were not associated with intrauterine insemination, (3) most reported cases of infection fail to show evidence for the actual presence of infection, and (4) the prevalence is unaltered by the administration of prophylactic antibiotics or washing the semen sample with antibiotics.     

Release of soluble transferrin receptor from the surface of human leukemic HL60 cells

Information regarding transferrin (Tf) receptor degradation is largely incomplete. HL60 cells were shown to release to their growth medium a Tf-binding protein which could be immunoprecipitated by anti-Tf receptor monoclonal antibodies (MoAbs) B3/25 and OKT9. Soluble Tf receptor was detected in the medium within one hour of replating of cells, and its release was inhibited at 4 degrees C. The affinity of Tf for the soluble receptor released by cells (kd = 2.3 x 10(-10) mol/L) was slightly lower than its affinity for the detergent-solubilized cellular receptor (kd = 1.2 x 10(-10) mol/L). 125I-Tf internalized and released by cells subsequently bound to Tf receptor released by the same cells, and soluble Tf receptor in the conditioned medium (CM) inhibited 125I-Tf binding to intact cells. The soluble Tf receptor isolated from the CM was smaller (78,000 daltons) than the cell surface receptor (94,000 daltons) when analyzed by gel electrophoresis under reducing conditions. Isolated cell membranes readily released soluble receptor; however, this release could be blocked by protease inhibitors. The soluble Tf receptor may represent the extracytoplasmic domain of the cellular Tf receptor released from the surface of HL60 cells through proteolytic cleavage by a membrane-based protease.     

Effect of linoleic and oleic acids on blood pressure, blood viscosity, and erythrocyte cation transport

It has been proposed that dietary linoleic acid lowers blood pressure (BP) by being converted to arachidonic acid and prostanoids of the two-ene series. We tested the effects of linoleic acid on plasma arachidonic acid, blood pressure, blood viscosity, and RBC cation transport. Oleic acid, the major dietary monounsaturated fat and which is not a prostanoid precursor, was used as a control. Seventeen adults consumed 23 g/d of linoleic acid or oleic acid provided by genetic variants of safflower seed, each for 4 weeks in a double-blind crossover design. Linoleic and oleic acids were enriched significantly in the plasma cholesteryl esters, phospholipids and triglycerides during the respective periods of supplementation but there was no increase in arachidonate. Mean BP was 116.1/76.8 during ingestion of oleic and 113.6/74.6 during ingestion of linoleic acid (p = 0.09 systolic, p = 0.12 diastolic). The power of the study was over 75% for detecting a significant (p less than 0.05) effect of 4 mm Hg in systolic BP or diastolic BP. Whole blood and plasma viscosity, and RBC Li/Na countertransport, Na/K cotransport, and Na pump systems (Vmax) were unchanged during the protocol. Therefore, variations in dietary linoleic or oleic acids are unlikely to have major effects on BP or on several membrane-dependent erythrocyte functions related to hypertension.