Continuous ambulatory peritoneal dialysis

The technique of continuous ambulatory peritoneal dialysis was evaluated in nine patients during 136 patient weeks. The major objectives were to see if continuous ambulatory peritoneal dialysis would provide [1] acceptable control of serum chemistries by usual criteria, [2] adequate removal of sodium and water, [3] tolerable protein losses, and [4] a low prevalence of peritonitis with episodes responsive to therapy with continuing continuous ambulatory peritoneal dialysis. Preliminary findings suggest continuous ambulatory peritoneal dialysis represents an effective ambulatory, portable, internal dialysis technique. Larger-solute clearances per week may approach values six times greater than with most hemodialysis techniques. Small-solute clearances approach dialysate flow rate (8.3 ml/min) and are comparable to other dialysis techniques on a weekly basis. Edema is readily controlled and protein losses should be tolerable with adequate protein intake. Peritonitus occurs on the average every 10 weeks but responds to therapy promptly with continuing continuous ambulatory peritoneal dialysis. If the prevalence of peritonitis can be reduced, continuous ambulatory peritoneal dialysis appears to represent a very attractive dialysis technique.     

Onset of ovulation after menarche in girls: a longitudinal study

INTRODUCTION: Hypothalamic-pituitary axis maturity has been believed to be the rate-limiting step in the development of ovulatory menstrual cycles. We hypothesized that, given current nutritional conditions, hypothalamic-pituitary axis maturation would be relatively rapid in menarcheal girls. METHODS: Daily urine and menstrual records were collected for 2 yr each from 10 girls aged 11-13 yr at study entry. Urinary excretion of LH, FSH, estradiol (E1c), and progesterone (Pdg) metabolites was measured using established ELISAs. An objective algorithm detected rises of LH, FSH, E1c, and Pdg consistent with follicular maturation and/or ovulation. RESULTS: Nine of 10 girls enrolled into the study experienced the onset of menarche prior to or during the 2-yr collection period. LH and FSH surges, as well as small amplitude Pdg increments, were observed prior to menarche. Regular, ovulatory-appearing cycles with LH surges and gradually increasing and more sustained Pdg rises were observed over time after menarche, although duration of Pdg elevations remained shorter than in adult women (8.9 +/- 1.0 vs. 12.1 +/- 0.8 d, P = 0.043). E1c levels leading to LH/FSH surges were lower in perimenarcheal girls than adult controls, and bleeding episodes did not uniformly correlate with hormone patterns. Progressive increases in FSH and Pdg, but not LH or E1c, were observed in association with menarche. CONCLUSION: Mature hormone patterns are established within several months of and even prior to menarche in normal-weight perimenarcheal girls. Factors determining menstrual bleeding in perimenarcheal girls may not be solely dependent on reproductive hormones or the neuroendocrine axis.     

Prevalence, clinical features, and CPAP adherence in REM-related sleep-disordered breathing: a cross-sectional analysis of a large clinical population

Purpose  

Due to inconsistent definitions used in the literature, the prevalence of rapid eye movement (REM)-related sleep-disordered breathing (SDB) has been quite variable and its clinical significance remains unclear. This study aimed to compare the prevalence of and clinical characteristics between various criteria for defining REM-related SDB. We also investigated how frequently CPAP therapy was recommended in patients with REM-related SDB and if they had lower CPAP adherence compared to non-stage-specific SDB.     

Independent and incremental prognostic value of exercise thallium single-photon emission computed tomographic imaging in women

Background  

This study examined the independent and incremental prognostic value of exercise thallium single-photon emission computed tomographic imaging in 212 women who also underwent coronary angiography.     

Evaluation of thyroglobulin expression in murine reproductive organs during pregnancy

Citation Moravej A, Jeddi‐Tehrani M, Salek‐Moghaddam AR, Dokouhaki P, Ghods R, Rabbani H, Kazemi‐Sefat GE, Shahbazi M, Zarnani AH. Evaluation of thyroglobulin expression in murine reproductive organs during pregnancy. Am J Reprod Immunol 2010; 64: 97–103 Problem In pregnant women with antithyroglobulin antibody, prevalence of abortion is 2–4 fold higher compared to normal controls. Direct effect of such harmful autoantibodies on female reproductive organs may serve a role in pregnancy loss. Method of study Expression of thyroglobulin in decidua, placenta, and ovary of pregnant Balb/c mice ((Balb/c×Balb/c and Balb/c×C57BL/6) during early, middle, and late stages of pregnancy was evaluated. Expression of thyroglobulin was investigated in these tissues by semi‐quantitative RT‐PCR. In addition, polyclonal antithyroglobulin antibody was produced, and expression of thyroglobulin protein in aforesaid tissues was evaluated by immunohistochemistry and dot‐blot analysis. Results The results showed that thyroglobulin message is not expressed in placenta, decidua, or ovary in any stages of pregnancy. The same results were obtained at the protein level. Conclusion It is likely that antithyroglobulin antibodies have no direct detrimental effect on such organs in patients with thyroid autoimmunity suffering from recurrent abortion.     

Changing ethics in renal transplantation: presentation of Iran model

This article reviews renal transplant (RTx) activity in USA to show that the ethics of RTx are changing, with steadily increasing numbers of living unrelated donors (LURD). In developing countries the numbers of RTx are inadequate emphasizing the need for controlled LURD RTx programs. The condemnation of all forms of compensated LURD RTx results in many patient deaths and the associated suffering is unethical. The Iran model, adopted in 1988, permits compensated and controlled LURD RTx. It has eliminated the RTx waiting list in Iran. At the end of 2002, among the 14,288 RTxs performed, 78% were from LURDs. The recipients of >50% of the kidneys from LURDs have been from the poor socioeconomic class of Iran. It has been recommended that each society should provide legally binding life-long benefits for LURDs.