Getting to the heart of a hidden epidemic--the American Heart Association''s dedication to women

The valves of the anterior urethra are a rare congenital malformation, but it can cause a significant deterioration of the uppermost urinary system due to their obstructive patterns. It's placed fundamentally in the peno-scrotal union or in the bulbous urethra. They can associate to the diverticula of the anterior urethra. The clinical manifestations can be varied, depending upon the age of the child and the degree of obstruction that provoque. The treatment is always surgical, although in some occasions they suffice the endoscopic resection. We present the 12 cases controlled in our Center, with known ages between 1 month and 7 years, that began with tumefaction urethral at micturition in 7 cases, urinary infection in 6 and sepsis in 2. All of them required open surgery, after the failure of endoscopic resection in one of them. The results have been favorable in 9 cases regarding to the repercussions in the renal function. Two patients had a need of nephrectomy and one had to be subjected to a renal transplantation. The jet at micturition after surgery is good in 10 cases. In one, there persists a subtle jet, although without clinical repercussions, and in one patient there appeared a slight dilation in the posterior urethra.     

Respiratory failure in Guillain-Barré syndrome: a 6-year experience

Seventy-nine patients with acute Guillain-Barré syndrome were seen during a 6-year period. Twenty-one were admitted to a respiratory intensive care unit, where they remained for 58 +/- 26 days (range 14 to 105 days). Thirteen patients required nasotracheal intubation followed by tracheostomy and mechanical ventilation. The tracheostomy tube was in place for an average of 50 +/- 27 days (range 10 to 104 days). Four patients had complications of tracheostomy; two of these were significant, and one of them led directly to the patient's death. There were no complications due to mechanical ventilation, from which 11 patients were successfully weaned after a mean period of 37 +/- 29 days (range 7 to 93 days). Three of the 79 patients (3.8%) died of complications of their disease or its treatment. Respiratory failure in this condition is protracted and its complications are mainly those of prolonged endotracheal intubation with a tracheostomy tube.     

Interactions between carotid sinus mechanoreceptor and chemoreceptor reflex loops

n-Alkane assimilating yeast, Candida tropicalis YO-148, was grown on an n-alkane-containing medium. A synthetic diet containing 6.8% of dried yeast was fed to rats. The fatty acid composition of adipose tissue and liver fats was determined after a two week feeding period. The percentage of odd-numbered acids increased in the animals fed the yeast diet. Furthermore, it was shown that heptadecenoic acid, the major odd-numbered acid in yeast, was accumulated in neutral lipid fraction of adipose tissue fat. Fatty acid composition of protein isolate prepared from yeast cells had a profile similar to that of the original cells.     

Hemodynamic sequelae of regression of experimental atherosclerosis

Regression of experimental atherosclerosis is characterized by decreased intimal thickness and luminal enlargement, but intimal fibrosis becomes more dense. We tested the hypothesis that fibrosis of arteries during regression might limit vasodilator capacity and restrict hemodynamic improvement despite luminal improvement. We studied limb, coronary, and cerebral hemodynamics in 11 normal cynomolgus monkeys, 10 monkeys given an atherogenic diet for 20 mo and 8 monkeys given a regression diet for an additional 18 mo. The atherogenic diet induced lesions of moderate severity (50-60% stenosis); owing to characteristic vessel growth during the atherogenic period, luminal size did not decrease correspondingly. Regression monkeys showed typical changes of regression with luminal enlargement but increased fibrosis. The iliac artery was perfused at constant blood flow and maximal vasodilatation was produced with papaverine. Blood flow was measured with microspheres during maximal vasodilatation in the coronary bed (adenosine) and cerebral bed (hypercapnia). In normal monkeys, minimal vascular resistances were 1.95 +/- 0.19 mm Hg/ml/min X 100 g (mean +/- SE) (limb), 0.13 +/- 0.01 (coronary), and 0.44 +/- 0.02 (cerebral). In atherosclerotic monkeys minimal resistance increased (P less than 0.05) 108, 62, and 166% in the limb, coronary, and cerebral beds, respectively. In regression monkeys, minimal resistance increased from values found in atherosclerotic animals in the limb (+22%), decreased inconsistently in the coronary bed (-19%), and decreased significantly in the cerebral bed (-44%, P less than 0.05). Thus morphologic regression was accompanied by significant hemodynamic improvement during maximal dilatation only in cerebral vessels. We conclude that increases in luminal size during regression of atherosclerotic lesions may not be associated with increases in vasodilator capacity, as intimal fibrosis may limit physiologically important hemodynamic improvement.     

Audit: teaching medical students in general practice

Audit is being seen as an increasingly important topic for medical students. Many departments of general practice in the UK now incorporate audit as part of their course work. It remains controversial as to whether this is perceived to be worthwhile by the students. Following an introductory seminar final-year medical students at the University of Glasgow were asked to perform a case-note review of 10 randomly chosen diabetic patients for a number of process and outcome measures during their practice attachments. Feedback was given in their final teaching session. 128/153 (84%) students completed an evaluation of the course on their knowledge and attitudes to audit. Unsurprisingly, 39% found the data collection boring or very boring; however, 60% found the feedback session very interesting or interesting. Both the data collection and the feedback were considered relevant by the majority of students (57% and 70% respectively). Students' self-reported knowledge also dramatically increased (P < 0.0001).     

A flow cytometric method for counting very low levels of white cells in blood and blood components

Reduction of white cells (WBCs) in blood components may reduce the risk of virus transmission and HLA alloimmunization. Filtration provides a means by which to achieve high-efficiency WBC reduction. A method has been developed using flow cytometry to quantitate the number of WBCs in WBC-reduced packed red cells or platelet concentrates. This method uses a detergent and propidium iodide (PI) solution to label the WBC nuclei and incorporates a known amount of fluorescein isothiocyanate (FITC)-labeled chicken red cells (cRBCs) into the mixture as an indicator of the volume examined. The number of observed WBCs per mL is calculated as follows: Number of PI WBC nuclei events/Number of FITC cRBC events x Number of FITC cRBCs added to mixture/Volume of blood in mixture. The method may allow the detection of WBCs at a concentration as low as 0.01 per microliters (10/mL) in a blood sample. It is an efficient method of collecting data, as it requires less than 10 minutes per sample. This flow cytometric technique is suitable for research purposes and for quality control of WBC-reduced blood components, because it is precise and can be used to quantitate WBCs in large or small numbers in a sample.     

D-Arg1,D-Phe5,D-Trp7,9,Leu11]Substance P acts as a biased agonist toward neuropeptide and chemokine receptors

Substance P derivatives are potential therapeutic compounds for the treatment of small cell lung cancer and can cause apoptosis in small cell lung cancer cells in culture. These peptides act as broad spectrum neuropeptide antagonists, blocking calcium mobilization induced by gastrin-releasing peptide, bradykinin, cholecystokinin, and other neuropeptides. We show that [D-Arg1,D-Phe5,D-Trp7,9, Leu11]substance P has unique agonist activities in addition to this described antagonist function. At doses that block calcium mobilization by neuropeptides, this peptide causes activation of c-Jun N-terminal kinase and cytoskeletal changes in Swiss 3T3 fibroblasts and stimulates migration and calcium flux in human neutrophils. Activation of c-Jun N-terminal kinase is dependent on the expression of the gastrin-releasing peptide receptor in rat 1A fibroblasts, demonstrating that the responses to the peptide are receptor-mediated. We hypothesize that [D-Arg1,D-Phe5,D-Trp7,9, Leu11]substance P acts as a biased agonist on neuropeptide and related receptors, activating certain guanine nucleotide-binding proteins through the receptor, but not others.