Critical pharmacologic management in the emergency department

PURPOSE: Starting from a status hypercoagulability previous to substitutive hip and knee surgery, the aim of this work was to investigate the influence of different osteoarthropatic pictures for which arthroplasty is indicated in the activation of the clotting cascade, rheumatoid arthritis (RA) being one of such pictures. PATIENTS AND METHODS: Of 79 patients suitable for prosthetic surgery of hip (53) and knee (26), the preoperative values of several markers, namely, D dimers (D-D), thrombin-antithrombin (TAT) complex, and F1 + 2 prothrombin fragment (F1 + F2) were assessed by enzymoimmunoasay. The mean age of the patients was 65.5 years, and their sex distribution was 50 women and 29 men. The indications for arthroplasty were as follows: osteoarthrosis (62), aseptic necrosis (11), RA (9), articular gout (2), previous fracture (2), more than one diagnosis overlapped in some cases. The results attained were compared with a control group comprised of 33 subjects (16 women and 17 men) with mean age similar to the patient's group (68.06 years). RESULTS: The D-D values in the patients suitable for hip arthroplasty and the TAT values in patients suitable for both types of surgery were significantly higher than those found in the control group (p = 0.012 and 0.01, respectively). The preoperative TAT levels of the RA patients were significantly higher (p = 0.025) than those found in the patients with the other surgical indications. CONCLUSIONS: Previously to the performance of arthroplasty, the patients show hypercoagulative marker values higher than those of age-matched controls. The significant rising of TAT found in RA patients is concordant with the literature, and this fact makes it advisable to include RA among the pathologic situations associated with hypercoagulability, as this is a common indication for substitutive hip and knee surgery with high risk of venous thromboembolic disease.     

Frozen storage affects the compressive creep behavior of the porcine intervertebral disc

STUDY DESIGN: A biomechanical study of the compressive creep behavior of the porcine intervertebral disc before and after frozen storage. OBJECTIVE: To determine whether frozen storage alters the creep response, hydration, and nuclear swelling pressure of the intact intervertebral disc. SUMMARY OF BACKGROUND DATA: The mechanical response of the disc is dominated by swelling and fluid flow, whose effects are time-dependent. Because fluid content, which may change during storage, plays a significant role in the disc's time-dependent behavior, changes in mechanical response due to freezing may have been missed in previous studies that focused on time-independent behavior only. METHODS: Porcine intervertebral discs were tested in repeated cycles of compressive creep either immediately postmortem or after 3 weeks of frozen storage. Swelling pressure and nuclear hydration were also measured in fresh and frozen discs. A fluid transport model was used to analyze the creep data. RESULTS: The creep behavior of the intact porcine intervertebral disc is dramatically affected by frozen storage. The apparent permeability of the frozen discs was 82% higher than that of the fresh discs, and the swelling pressure of frozen discs was 25% lower in frozen discs (P < 0.01). The behavior of fresh and frozen discs became more dissimilar with repeated cycles of creep. CONCLUSIONS: In vitro tests of frozen porcine intervertebral discs do not represent fresh behavior. Frozen storage appears to permanently alter disc behavior. The precise nature of any freezing-induced damage, and whether frozen storage similarly affects human discs, remains to be seen.     

Syndromes and arthritis

There are many questions and no clear answers raised by these children. These syndromes, however, seem to be biologic experiments of nature and present unique opportunities to study the various elements involved in the pathogenesis of arthritis. Pediatric rheumatologists are in a unique position to study these syndromes.     

Macrophage colony-stimulating factor release and receptor expression in bone cells

Colony-stimulating factors (CSF) may play a role in bone resorption. To examine whether osteoblasts secrete colony-stimulating activity (CSA) in response to parathyroid hormone (PTH) and parathyroid hormone-related peptide (PTHrP), conditioned medium (CM) from ROS 17/2.8 cells and primary rat osteoblasts were examined for induction of clonal growth of cultured rat bone marrow cells. Untreated cells constitutively secreted CSA, which increased with PTH and PTHrP treatment. The colonies formed were principally comprised of macrophages, and preincubation of CM with antiserum to murine macrophage colony-stimulating factor (M-CSF) neutralized most of the CSA, suggesting that the osteoblast-derived CSA was predominantly due to M-CSF. PTHrP treatment upregulated steady-state M-CSF mRNA levels. To investigate a paracrine role for M-CSF in bone we examined bone tissue and cells for the M-CSF receptor c-fms using immunohistochemical techniques and demonstrated staining of mature osteoclasts both in situ and after isolation. We conclude that M-CSF is responsible for the majority of the CSA released by PTH- and PTHrP-treated rat osteoblasts. In addition we identified CSF-1 receptor expression in mature osteoclasts. These data suggest that M-CSF is a mediator of osteoblast-osteoclast interaction in PTH- and PTHrP-induced bone resorption.     

The specificity of split renal membranes in hereditary nephritis

This study was undertaken to assess the specificity of split renal basement membranes in hereditary nephritis (HN). Thirteen specimens from eight patients with HN were mixed in a random fashion with specimens from control patients with either idiopathic nephrotic syndrome or various forms of glomerulonephritis and with specimens from patients with benign recurrent hematuria (BRH). Each biopsy specimen was scored for splitting of glomerular basement membranes (GBMs). Control and BRH specimens contained focal splitting in the GBMs; the biopsy specimens from HN patients had widespread lesions. Evaluation of split GBMs is useful in differentiating patients with HN from those with BRH and other renal diseases that may be confused with HN.     

Radiology in primary hyperaldosteronism

Autonomous hypersecretion of aldosterone (primary hyperaldosteronism) is caused by either hyperplasia (usually bilateral) or an adenoma (frequently unilateral) of the adrenal cortex. Systemic hypertension due to an aldosteronoma is a potentially curable condition through surgical extirpation of the offending organ. In our experience with 37 patients clinically suspected to have primary hyperaldosteronism, radiological methods contributed significantly in preoperative diagnosis. These included (1) selective bilateral adrenal vein catheterization and blood sample collection, (2) adrenal venography, and (3) radioisotope adrenal scan. Unilateral hyperfunction could be accurately detected by the aldosterone assays from the collected samples. When adrenal venography was technically satisfactory, a nodule or aggregate of nodules measuring at least 7 mm and located on the margin of the gland or 1.5 cm or more in diameter when located in the center of the gland were readily identified. Enlarged adrenal gland on venography, in itself, was not a dependable index of a hyperfunctioning gland. Presence of a higher uptake on one side on the radioisotope adrenal scan did not always indicate the hyperfunctioning gland, but lack of lateralization of adrenal hyperfunction was more accurately predicted on the radioisotope scan than by venography. Four histopathological patterns were recognized in the surgically removed adrenal glands, but no correlation between these patterns and clinical behavior or postoperative course was found.     

Interkinetic nuclear migration in nasal placode of chick embryo

Cells of nasal placode of chick embryos were studied with thymidine H3 and autoradiography. Our results shown, that the nuclei in the nasal placode synthesize DNA in the outer zone, then migrate toward the inner zone to undergo division and subsequently return to the outer zone.     

Insect feeding and oviposition deterrents from western red cedar foliage

The feeding deterrent activity of fractions from the foliage of western red cedar,Thujaplicata Donn, was studied in laboratory bioassays using the white pine weevil,Pissodes strobi Peck, as a test insect. The most active fraction was the volatile mixture that comprises the leaf oil of this tree species. Further fractionation of the leaf oil indicated feeding deterrent activity in the monoterpene hydrocarbon, thujone, and terpene alcohol fractions. When tested alone, both (–)-3-isothujone and (+)-3-thujone, which made up 75–88% and 5–10% of the leaf oil, respectively, deterred feeding by the weevils. Western red cedar leaf oil also showed antifeedant activity with the alder flea beetle,Altica ambiens (Le Conte), and served as an oviposition deterrent for the onion root maggot,Hylemya antiqua Meigen. The leaf oil, however, had no inhibitory effect on the feeding of the leaf roller,Epinotia solandriana L., and the red-backed sawfly,Eriocampa ovata L.Research supported by the Natural Science and Engineering Research Council, Canada, Co-op Grant No. A0243 and Operating Grant Nos. A3881 and A3706, and by the British Columbia Ministry of Labour Youth Employment Program.     

Ophthalmoplegia and Ondine's curse

Ocular abnormalities and psychomotor difficulties were prominent in two unrelated children; in addition, the older child had respiratory irregularity during sleep. The pathologic findings included lesions of the optic nerve in the case with available material and established the diagnosis of Leigh's subacute necrotizing encephalopathy. This disorder is thought to result from inhibition of a thiamine-dependent enzymatic process and may be modified by greatly increased thiamine intake. Suspicion of the diagnosis in a child with ophthalmoplegia or other ocular abnormalities may lead to earlier recognition and more successful treatment of the disease.