Delay in obstetrical care in newly diagnosed teenage pregnancy.

A retrospective study of 42 adolescent patients diagnosed as being pregnant between June 1987 and February 1990 at the Downtown Health Center (DHC), an inner city pediatric primary care clinic, was conducted to determine whether patients referred to a hospital-based Teen Pregnancy Clinic (TPC) were seen within a reasonable period of time. The frequency of sexually transmitted diseases (STDs) was also determined when these women were initially seen at TPC. Only 5 of the 42 patients seen at DHC had a pelvic exam prior to referral. Of the 40 patients seen at TPC, 20% were not seen until four weeks or more after initial diagnosis. Fifty percent had a STD. Pediatricians should recognize that pregnant teenagers may have a significant delay between diagnosis of pregnancy and entry into obstetrical care. Pelvic exam including cultures for STDs is recommended prior to referral.     

Acute glomerulonephritis secondary to lobar pneumonia

We report 4 cases of children who developed lobar pneumonia and subsequently acute glomerulonephritis, all within a period of six weeks. In one case streptococcus pneumonia type 5 was isolated, a strain not previously described in the literature as being nephritogenic.     

Role of glomerular prostanoid in control of glomerular filtration rate in rats

Summary It is generally accepted that the main action of glomerular prostanoids (GPs) on glomerular filtration rate (GFR) is to modulate the activity of different vasoconstrictors, specially in states of renal hypoperfusion. However it was also suggested that GPs may directly affect GFR. The present study was focused on this last hypothesis, in different experimental models, in rats.In adriamycin induced acute renal failure, the transient decrease of GFR is associated with higher levels of thromboxane B₂. Later on, when GFR returns to normal, vasodilator prostaglandins synthesis was also increased.In captopril induced renal failure in Na depleted rats (where GPs synthesis remained normal), stimulation of PGE₂ and PGI₂ production by K and NaCl was associated with a significant improvement of GFR. Furthermore, the increase in GFR induce by NaCl was prevented by inhibition of prostaglandin synthesis.Infusion of atrial natriuretic peptide in euvolemic rats induce a marked elevation both of GFR and PGE₂ synthesis. It was abolished by previous administration of prostaglandin synthesis inhibitor.In conclusion, glomerular prostanoids may influence GFR, either directly, or as mediator or modulator of other vasoactive hormones.Abbreviations GPs glomerular prostanoids - PG prostaglandin - TX thromboxane - ANP atrial natriuretic peptide - GFR glomerular filtration rate - PE polyethylene Nachtrag zu den Hauptreferaten des 19. Kongresses der Gesellschaft für Nephrologie in Göttingen (Klin Wochenschr 66/18)     

Budesonide Versus Acetazolamide for Prevention of Acute Mountain Sickness

Background

Inhaled budesonide has been suggested as a novel prevention for acute mountain sickness. However, efficacy has not been compared with the standard acute mountain sickness prevention medication acetazolamide.

Impaired migration of trophoblast cells caused by simvastatin is associated with decreased membrane IGF-I receptor, MMP2 activity and HSP27 expression

BACKGROUND: Statins inhibit 3-hydroxy-3-methylglutaryl coenzyme-A reductase, the rate-limiting enzyme of the mevalonate pathway, and are used successfully in the treatment of hypercholesterolaemia. Statins are contraindicated during pregnancy. Lately, we have shown that simvastatin has adverse affects on human first trimester placental explants' proliferation and migration. The objective of the present study was to investigate the molecules involved in mediating simvastatin's effect on trophoblast cell migration. We hypothesized that simvastatin attenuates insuline-like growth factor-I (IGF-I) receptor expression (involved in trophoblast motility), matrix metalloproteinase (MMP) activities, and heat shock protein 27 (HSP27) levels (whose mRNA is actively transcribed during trophoblast differentiation) in trophoblast cells thus consequently effecting their migration. METHODS: Human placental explants were cultured above a matrigel with/without simvastatin (10 microM) for 5 days. In this model, trophoblast migrates from the villi into the matrigel. Western-blot and immunohistochemistry served for analysing HSP27 expression. Immunohistochemistry was used for assessing IGF-I receptor localization. MMPs activity was assayed by gel zymography. RESULTS: Simvastatin reduced IGF-I receptor membranal expression, MMP2 activity and HSP27 expression in trophoblast cells (P < 0.05). CONCLUSIONS: The inhibitory effect of simvastatin on trophoblast cell migration is associated with a significant decrease in the tested molecules, which probably contributes to the impaired migration.     

Saphenous has weak ineffective synapses in sciatic territory of rat spinal cord: electrical stimulation of the saphenous or application of drugs reveal these somatotopically inappropriate synapses

In a previous paper, we showed that chronic denervation of the sciatic nerve for more than 21 days in adult rats caused expansion of the saphenous nerve into sciatic territory in the spinal cord (medial L4, L5 and L6). To try to explain this expansion in the present paper, we tested the hypothesis that weak ineffective synapses of saphenous terminals are always present in sciatic territory. For this purpose the sciatic nerve was acutely denervated, the cord mapped with microelectrodes and responses evoked in single cells with natural (mechanical cutaneous) or electrical (pulses to saphenous nerve) stimulation. In the sciatic territory, no natural responses occurred but electrically evoked responses from the saphenous were everywhere. When drugs were applied to potentiate synaptic activity, many of the silent neurons in the sciatic territory in L4, L5 and L6 responded to natural inputs mediated by the saphenous. Picrotoxin was more effective than 4-aminopyridine which was more effective than strychnine in expressing these weak somatotopically inappropriate saphenous inputs. All together, these results support the hypothesis that weak ineffective saphenous inputs exist in sciatic territory of the spinal cord. They can be artificially expressed with electrical volleys or chemical potentiation and may be naturally expressed several weeks after chronic lesions of the sciatic nerve.     

Hypercalcaemia-induced acute renal failure as a presenting feature of T-cell leukaemia

A 14-year-old patient presented with hypercalcaemia-induced acute renal failure. Investigation yielded a diagnosis of T-cell leukaemia. Chemotherapy resulted in complete remission, a return of serum calcium levels to normal and consequent improvement of renal function.Abbreviations ARF acute renal failure - PTH parathormone