ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundPuromycin aminonucleoside (PAN) nephropathy is a widely studied model of glomerular sclerosis (GS) in the rat, and cholesterol feeding exacerbates the injury induced by PAN. The importance of the interaction of angiotensin II (Ang II) with the AT2receptor is unclear. We investigated the role of the renin-angiotensin system, particularly with regard to AT1and AT2receptor dynamics, in PAN and cholesterol-mediated GS.MethodsSprague-Dawley rats were given a 4% cholesterol diet (group II), subcutaneous PAN (group III), or a 4% cholesterol diet and PAN (group IV) and compared with a control group given PAN vehicle (group I). After 16 weeks, kidneys were harvested and tissue Ang II concentration, angiotensin-converting enzyme (ACE) activity, and ACE, AT1, and AT2mRNA levels were determined.ResultsCompared with control rats, proteinuria was significantly higher in groups II to IV. Kidney ACE activity and ACE mRNA levels in groups III and IV were 2- and 3-fold higher than in groups I and II, respectively. Kidney Ang II concentration also was increased in the experimental groups. Whereas kidney AT1mRNA was significantly lower in groups III and IV, kidney AT2mRNA was significantly increased in groups II to IV.ConclusionIn these experimental models of GS, there is significant activation of the tissue-based renin-angiotensin system. Puromycin with and without cholesterol decreased the AT1receptor mRNA and increased the AT2receptor mRNA. Up-regulation of AT2receptors may be important in ameliorating the proliferative effects of Ang II, which presumably occur through the AT1receptor.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundThe study reported here assessed the implementation of recommendations for routine universal prenatal counseling and voluntary HIV testing among Alabama physicians who provide prenatal care and determined factors associated with noncompliance.MethodsVoluntary, confidential mailed survey of obstetrics and family medicine practitioners.ResultsOf the 138 physicians who responded to a mailed survey in Alabama, 17 (12.3%) indicated that they did not offer universal HIV counseling and testing to pregnant women. Factors associated with failure to offer universal HIV counseling and testing included having more than 50% of patients refuse HIV counseling and testing when offered and never knowingly having given prenatal/perinatal care to women with HIV. Low/medium familiarity with the US Public Health Service recommendations for perinatal zidovudine use to reduce HIV transmission and physician specialty are also suggested as predictors of not offering universal testing.ConclusionsDespite the well-established benefits of antiretroviral prophylaxis to prevent vertical transmission of HIV, some physicians in Alabama have been slow to adopt universal testing of their pregnant patients for HIV in the prenatal period. Practitioner education is as important as patient education in eliminating pediatric HIV in the Deep South.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundRecent studies suggest a complex association between smoking and retinopathy that probably depends on the interaction between many variables. We have reported an association between ACP1 phenotype and retinopathy in type 1 diabetes. Additionally, the deleterious effects of smoking on intrauterine growth are dependent on ACP1, a low-molecular-weight tyrosine phosphatase that modifies signal transduction. We examine here the interaction between smoking and ACP1 as a mediator of susceptibility to diabetic retinopathy in a sample of puerperae with type 1 diabetes.Subjects and MethodsSeventy-eight women who had just delivered live infants were studied. ACP1 phenotype was determined by starch gel electrophoresis. Three-way contingency tables were analyzed.ResultsThere is a significant epistatic interaction between smoking and ACP1 phenotype concerning their effects on retinopathy. In subjects with low ACP1 activity, frequency of retinopathy was slightly higher in smokers than in nonsmokers. However, in subjects with medium-high ACP1 activity, frequency of retinopathy was significantly lower in smokers than in nonsmokers. A logistic regression analysis using retinopathy as the dependent variable revealed that smoking, ACP1, and ACP1 by smoking interaction, as well as the interaction between smoking and age of the women, are the most robust predictors of retinopathy.ConclusionsThe effect of smoking on retinopathy in women with type 1 diabetes depends on many variables, which supports the hypothesis of complex interactions between smoking and other variables in the pathogenesis of this disease. Variability of genetic factors involved in signal transduction may affect endothelium proliferation through the regulation of growth factors and through regulation of glycemic levels. Because cigarette smoke influences signal transduction, its impact on diabetic retinopathy may be mediated by ACP1.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

A 41-year-old woman who had undergone transfrontal craniotomy for a pituitary tumor 4 months before presentation was admitted with confusion and orientation only to self. She had a fever of 40°C. Serum sodium and chloride levels on admission were 180 and 139 mEq/L, respectively. Measured serum osmolality was 380 mOsmol/L with a urine osmolality of 360 mOsmol/L. Magnetic resonance imaging revealed a 1.5-cm mass in the sella turcica, which was nonfunctioning on endocrine evaluation. The “bright spot” of a normal posterior pituitary was absent. Central diabetes insipidus was confirmed by a 300% increase in urine osmolality with desmopressin. The patient survived her severe hypernatremia, which has 70% mortality with a serum sodium level of 160 mEq/L or above. However, she developed permanent (6 months) disorientation to time and place even when hypernatremia was corrected, which has not been described previously.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Pituitary adenoma with growth hormone (GH) and corticotropin (ACTH) production causing apparent acromegaly and Cushing disease is extremely rare. A 45-year-old woman had a pituitary macroadenoma and severe insulin resistance. Physical examination showed a fully developed acromegaly associated with mild Cushingoid features. Serum GH, insulin-like growth factor-I, ACTH, and cortisol levels were all elevated. Hormonal loading tests resulted in GH levels increasing paradoxically in response to thyrotropin-releasing hormone (TRH), but not corticotropin-releasing hormone (CRH). A similar unexpected increase in ACTH and cortisol levels occurred in response to TRH and GH-releasing hormone. After trans-sphenoidal resection of the pituitary macroadenoma immunohistochemistry revealed the presence of either diffuse but faintly GH-positive cells or sparse but distinct ACTH-stained cells. A marked amelioration of insulin resistance was observed postoperatively. The elevated ACTH and cortisol levels should therefore be investigated by CRH and dexamethasone suppression tests for the coexistence of Cushing disease to exclude the possibility of underlying ACTH-producing tumors.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

A 47-year-old man with renal cell carcinoma underwent nephrectomy, and postoperative chemotherapy was performed with recombinant &agr;-interferon. Five years later, he experienced dyspnea during physical exertion. An echocardiogram revealed dilatation and systolic dysfunction of the left ventricle, and thallium-201 myocardial scintigraphy showed diffuse heterogeneous perfusion. We diagnosed congestive heart failure because of cardiomyopathy induced by &agr;-interferon therapy. Withdrawal of interferon therapy and the combination of an angiotensin-converting enzyme inhibitor, diuretics, and digitalis improved left ventricular systolic function. Furthermore, myocardial scintigraphy using [123I]&bgr;-methyl-p-iodophenylpentadecanoic acid (123I-BMIPP) or [123I]metaiodobenzylguanidine (123I-MIBG) revealed normal perfusion after the improvement of congestive heart failure. This is a rare case of interferon-induced cardiomyopathy that resulted in normal myocardial images in123I-BMIPP and123I-MIBG scintigrams after withdrawal of interferon therapy.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PurposeTo examine the prevalence and characteristics of arterial thromboembolism in patients with adenocarcinoma of the pancreas.MethodsRetrospective review of charts of all patients with cancer of the pancreas diagnosed and followed at a regional teaching hospital over a decade.ResultsIn total, 320 patients were diagnosed and 311 were available for evaluation. Two patients with arterial thromboembolism were identified (0.65%) and studied. Both had extensive metastatic disease on diagnosis and, soon after, developed an acute arterial occlusion of the iliac and femoral arteries, with no identifiable embolic source (case 1) or acute intestinal infarction due to mesenteric and multiple other embolic arterial occlusions associated with nonbacterial thrombotic endocarditis (NBTE) of the mitral valve (case 2). Both cases had laboratory evidence of disseminated intravascular coagulation and succumbed to their illnesses within a very short time.ConclusionArterial occlusion in pancreatic cancer is a rare preterminal event that may be caused by cardiogenic emboli from NBTE or to thrombosis in situ. The pathogenesis is briefly reviewed.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Intravascular lymphomatosis is an unusual form of non-Hodgkin lymphoma characterized by intravascular proliferation of atypical lymphoid cells in multiple organs. It can cause systemic inflammatory response syndrome due to primary release of cytokines by the tumor cells or secondary release of cytokines after vascular occlusion by the tumor cells. It is a potentially fatal condition, because multiorgan failure can ensue due to thrombotic vascular occlusion. This is a very rare condition and most cases are diagnosed post mortem. We present a case of systemic inflammatory response syndrome and subsequent death from multiorgan failure in a patient with intravascular lymphoma.

ISSN:0002-9629    

出版商:OVID    

年代:2002

数据来源: OVID