Adrenal and pseudoadrenal masses: CT and US findings

Computed tomography (CT) is currently the imaging modality of choice for assessing the morphology of the adrenal glands in adult patients. Much useful information can be gained using CT in disease processes which primarily involve one or both of the adrenal glands, such as adenomas, as well as in entities which secondarily affect the adrenals, such as pituitary or metastatic disease. The size and configuration of the glands can be readily determined, and masses may be detected. We discuss CT of normal and abnormal adrenal glands with sonographic (US) and pathological correlation, when available. Entities which may mimic adrenal abnormalities are emphasized. Relative advantages of US over CT in the pediatric patient are discussed.     

Ureteral obstruction in the neonatal rat: Renal nerves modulate hemodynamic effects

In the neonate, chronic unilateral ureteral obstruction (UUO) reduces renal blood flow (RBF) of the ipsilateral kidney and increases RBF of the opposite kidney. To determine whether renal nerves mediate or modulate these responses complete left UUO in the neonatal rat was used as a model of severe obstructive uropathy, and was compared with sham-operated controls. At 24–28 days of age, animals underwent left or right mechanical renal denervation or left sham renal denervation. One week after denervation, animals were anesthetized and blood pressure and heart reate were measured. Cardiac output and RBF were determined by the radioactive microsphere technique. UUO increased blood pressure and heart rate, and decreased RBF in the obstructed kidney, regardless of denervation. While left UUO increased RBF to the intact opposite kidney in rats with left renal denervation, this was attenuated by right renal denervation. Thus, in the neonatal rat, UUO modulates systemic renal hemodynamics, possibly through activation of the renin-angiotensin system. While renal nerves do not mediate the vasoconstriction of the obstructed kidney, renal nerves modulate vascular tone of the kidney contralateral to UUO.     

7-甲氧基-4′-羟基-3′-二乙胺甲基异黄酮(MHDF)对大鼠血流动力学和主动脉的作用

本实验观察了MHDF对整体大鼠血流动力学和离体大鼠胸主动脉的作用。结果表明iv MHDF(3～12.8 mg/kg)能降低大鼠左心室±dp/dt_max,V_max,V_pm和LVSP,延长T-dp/dt_max,减慢心率。MHDF还能舒张大鼠胸主动脉,ED₅₀为6.5×10^-6mol/L;非竞争拮抗NA和CaCl₂致主脉收缩,pD₂′为3.11±0.21和3.73±0.07;抑制高K⁺致主动脉收缩,IC₅₀为1.76×10^-5mol/L。提示MHDF对血管的作用与α受体阻断剂不同,而可能与钙拮抗有关。     

Surgical treatment of osteoarthritis of the shoulder

Shoulder dysfunction is unusual in osteoarthritis and usually responds to conservative treatment. The primary indication for surgery is pain unresponsive to medical management. The procedure of choice for degenerative changes in the glenohumeral joint is hemiarthroplasty or total shoulder replacement depending on the condition of the glenoid. Shoulder fusion is rarely necessary for osteoarthritis and is recommended for chronic infection, flail shoulder, and failed total shoulder replacement not amenable to revision. Joint resection is reserved for infected joints with massive bone loss. The results of shoulder arthroplasty are good to excellent in 86 to 94 per cent of all patients. The results of shoulder arthrodesis are less predictable, but are usually satisfactory in approximately 75 per cent of patients with 10-year follow-up. The treatment of AC and SC joint arthritis is conservative with rest, local heat, and medication. Pain unresponsive to this regimen is an indication for resection of the joint. Good results with this procedure directly correlate with pain relief on injection of the joint with local anesthetic.     

Transvaginal ultrasound detection of multifollicular ovaries in non-hirsute ovulatory women.

OBJECTIVES: To characterize ovarian morphology in a group of ovulatory, non-hirsute women with infertility and normal circulating levels of gonadotropins and sex steroids. METHODS: Thirty-three women with normal physical examinations, regular ovulatory menses, and absence of hirsutism (Ferriman-Gallwey score < or = 7) were studied. No woman had thyroid disease, galactorrhea, polycystic ovary syndrome, 21-hydroxylase deficiency or diabetes. Two-dimensional (2D) transvaginal sonography (TVS) was used to measure follicle size and ovarian volume on menstrual cycle day 5. Three-dimensional (3D) TVS images were stored to determine the number of follicles (measuring 2-10 mm in diameter) in the largest sonographic plane. Fasting blood sampling and oral glucose tolerance testing were performed to assess serum gonadotropin and sex steroid levels as well as glucose tolerance. RESULTS: The median ovarian volume by 2D-TVS imaging was 7.2 (range, 2.3-15.8) cm(3) (n = 64 ovaries). No follicles were > 10 mm in diameter. The median number of follicles by 3D-TVS was 4 (range, 2-8) (n = 63 ovaries) in the largest sonographic plane. Fourteen of 63 ovaries (22%) had six or more small follicles in one plane distributed within normal stroma (multifollicular ovary, MFO). No ovary had 10 or more follicles in one plane located within abundant stroma (polycystic ovary). Of 33 women examined, 20 women (61%) had apparently normal ovaries bilaterally, while 13 (39%) had at least one MFO. There were no significant differences between women with and those without MFO in serum gonadotropin and steroid levels or glucose tolerance. CONCLUSIONS: MFO is a common morphological variant in non-hirsute ovulatory women with normal gonadotropin secretion and ovarian steroidogenesis.     

Lack of effect of paracetamol on the pharmacokinetics of chloramphenicol.

The effect of oral paracetamol (1 g) on the pharmacokinetics of oral chloramphenicol (500 mg) was examined in five adult male Zimbabwean patients with normal hepatic and renal function. No significant alteration of half-life, area under the concentration-time curve or peak concentration of chloramphenicol was observed. The previously reported, potentially serious interaction between chloramphenicol and paracetamol administered intravenously was not observed with the more commonly used oral preparations.     

Buoyant density in cesium chloride of the human reoviruslike agent of infantile gastroenteritis by ultracentrifugation,electron microscopy,and complement fixation

The buoyant density in cesium chloride of the human reoviruslike (HRVL) agent of infantile gastroenteritis was studied utilizing electron microscopy and complement fixation (CF) for the detection of reoviruslike particles in fractions of the density gradient. Three virus positive stool filtrates were studied. “Full” reoviruslike particles had a density of 1.35–1.37 g/cm³, whereas “empty” particles had a density of 1.29 g/cm³. Peak CF activity coincided with the peak fraction of both the “full” and “empty” reoviruslike particles. In addition, by differential centrifugation, CF activity was also associated with the virion and not a “soluble” antigen.