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PubMed2002

Ghrelin-induced GH secretion in normal subjects is partially resistant to homologous desensitization by GH-releasing peptide-6.

OBJECTIVE: GH secretagogues and GH-releasing hormone (GHRH) exert a complex cross-talk at the somatotrope cell, and undertake homologous and heterologous desensitization. On the other hand, the discovery of ghrelin as a new factor implicated in the regulation of GH secretion makes a thorough assessment of its properties and cell biology processes mandatory. In order to implement this, three different testing schedules were devised using the administration, on the same day, of two GH stimuli administered in sequential order 120 min apart. The two aims of the study were (a) to evaluate the relative potency of ghrelin in comparison with other GH stimulants and (b) to assess the presence of homologous or heterologous desensitization between these compounds. DESIGN: The different testing days performed in random order were (a) on one day, saline was administered at time 0 min and ghrelin at time 120 min, (b) on another testing day, GHRH was administered at 0 min followed by ghrelin at 120 min and (c) on the last testing day, GH-releasing peptide-6 (GHRP-6) and ghrelin were injected at 0 and 120 min respectively. Ghrelin, GHRH and GHRP-6 were always administered at 1 microg/kg i.v., and plasma GH was measured. PATIENTS: Six normal subjects participated in the study after providing informed consent, and each was assessed on three different testing days, at least 1 week apart. RESULTS: Saline did not modify peak GH (means+/-s.e.) values (1.5+/-0.6 microg/l), and ghrelin administered 120 min later induced a significant GH rise (39.9+/-2.8 microg/l). On a different testing day, GHRH induced a GH peak (9.4+/-2.8 microg/l) lower than that of ghrelin injected 120 min later (26.8+/-4.7 microg/l). On the last testing day, GHRP-6 at time 0 induced a GH peak of 18.4+/-5.9 microg/l and ghrelin 120 min later a peak of 19.8+/-2.9 microg/l. The ghrelin-mediated GH secretion after GHRP-6 was significantly lower than the GH elicited by ghrelin when the preceding administration was saline. This demonstrated that ghrelin was partially affected by GHRP-6 and was not affected by GHRH. CONCLUSIONS: Calculated at equal mass doses or in molecular terms, ghrelin appears to be a more potent stimulus than GHRP-6 and GHRH. Ghrelin was completely insensitive to the previous administration of GHRH as well as relatively resistant to the homologous desensitization exerted by GHRP-6.

Adult↗
PubMed2003

Acute hemolytic transfusion reactions due to multiple alloantibodies including anti-E, anti-c and anti-Jkb.

We report a case of two consecutive episodes of acute hemolytic transfusion reactions (HTRs) due to multiple alloantibodies in a 34-yr-old man who suffered from avascular necrosis of left femoral head. He received five units of packed red blood cells (RBCs) during surgery. Then the transfusion of packed RBCs was required nine days after the surgery because of the unexplained drop in hemoglobin level. The transfusion of the first two units resulted in fever and brown-colored urine, but he received the transfusion of another packed RBCs the next day. He experienced even more severe symptoms during the transfusion of the first unit. We performed antibody screening test, and it showed positive results. Multiple alloantibodies including anti-E, anti-c and anti-Jkb were detected by antibody identification study. Acute HTRs due to multiple alloantibodies were diagnosed, and the supportive cares were done for 6 days. We suggest the antibody screening test should be included in the panel of pretransfusion tests for safer transfusion, and it is particularly mandatory for the patients with multiple transfusions, pregnant women, and preoperative patients.

Adult↗
PubMedDate not supplied

Diagnosis of depression in the elderly patient.

In the opening case study, Mrs. D.'s depressive symptoms should have been identified by the clinician, and the initiation of a complete workup should have been scheduled (see Figure 1 flow chart). Depression, although frequently difficult to diagnose in the elderly, is a common treatable illness. Screening for depression and asking the patient during routine visits about their mood will assist in identifying patients at risk. A systematic approach to the clinical evaluation, including a thorough history and physical examination, as well as laboratory tests necessary to identify comorbid medical conditions, is mandatory. Primary care providers need to be aware of confusing and confounding variables that may present in the patient's presentation. Once the diagnosis is made, a comprehensive treatment plan, including patient and family education, psychosocial intervention, and medication, when necessary, should be instituted. The primary care provider can positively affect the health and wellbeing of the elderly patient if they are diligent in the diagnosis and appropriate treatment of depression.

Aged↗
PubMed1992

[Quality control in the allergy laboratory--4 years "Allergy Ring Trial" in Austria].

In 1988 the Austrian Society for Allergology and Immunology initiated an external quality control program for the in vitro allergy diagnosis. In 12 mailings, 62 sera from allergic patients were sent to selected laboratories in order to determine total and antigen specific IgE according to the laboratory-specific methods. The values for total IgE varied considerably (73.9% were within +/- 1 SD, 94.3% within +/- 2 SD and 99.1% within +/- 2 SD, but only 0.9% beyond that). Sources of error were mainly attributable to inappropriate equipment and low quality reagents, but also bad test performance, with respect to personnel and the routines. In contrast, antigen specific IgE against pollen, mites, moulds, insect venoms, animal danders, drugs, parasites, environmental and food antigens revealed quite homogeneous results. Out of 1492 data, only 46 (3.1%) had to be declared as "wrong", and the variability of the RAST-classes was low. Whereas the quality of the reagents from all the different suppliers was not absolutely reliable at the beginning of the study, it improved considerably with time, as consequence of our complaints. The comparability of the methods for detecting total-IgE were non-satisfactory, whereas those for antigen specific IgE were generally good. The variety of methods employed (radio- and enzyme immunologic, fluoro- and nephelometric methods, etc.) should entail appropriate consequences, especially critical comparisons within one and the same laboratory; in addition, international standardization of the "normal" values should replace company-standards, and quality control programs for each test system before it is marketed should be mandatory. Our results confirm, that external control should be obligatory for any laboratory.(ABSTRACT TRUNCATED AT 250 WORDS)

Allergens↗
PubMed2005

Endovascular brachytherapy for the prevention of restenosis after femoropopliteal angioplasty. Results of the VARA Trial.

AIM: Endovascular brachytherapy (EBT) has been proposed as a method to prevent restenosis. We performed a prospective randomised multicenter study to determine its efficacy for prophylaxis of restenosis after femoropopliteal percutaneous transluminal angioplasty (PTA). METHODS: Patients with symptomatic stenotic or totally occluding lesions in the femoropopliteal artery were randomised to be treated with PTA plus EBT or PTA alone. In case of EBT, 14 Gy was applied by an 192Ir source to the vessel wall. Clinical examination, ankle-brachial pressure index (ABPI) and duplex ultrasound were planned after 6 and 12 months. The primary endpoint was significant restenosis of the treated segment at duplex ultrasound after 12 months. RESULTS: Fifty-three of the 60 patients who eventually met the inclusion criteria could be studied. After 12 months, restenosis rates were 44% (12/27) in the PTA group versus 35% (8/23) in the PTA + EBT group (c2 test, P=0.51). There was no difference in mandatory reintervention between the 2 groups. Overall, EBT resulted in an absolute risk reduction of significant restenosis of 9%, yet in patients with totally occlusive disease this reduction was 32%. CONCLUSIONS: This study suggests an effect of EBT on the occurrence of restenosis only after PTA of occluded femoropopliteal lesions. Due to a too small number of patients analysed this difference is not statistically significant.

Adult↗
PubMed1989

[Indications of immunologic evaluation in recurrent otorhinolaryngologic infections in children].

Happening of 3 to 5 E.N.T. infections per year is often the price to pay by the young child to obtain his immunological maturity. Frequency and seriousness of the recurrencies leading to surgical interventions, results of which being doubtful and temporary (specially in ear infections) enforce differentiated immunological evaluations: graduating in methodology will be in accordance with the seriousness of happening cases. Our method involves different steps. Usual investigations will lead to easy and efficient treatment: research of the deficiency of iron, titration of immunoglobulin and IgG2, screening for inhalant allergy (Phadiatop test), eventually completed by allergological check up. Suppurations due to unusual microbial agents or fungus, must lead to a wider immunological check up, specially in case of multiple localizations, and in familial background. This check up, testing humoral and cellular immunity (lymphocytes and polynuclears) is mandatory heavy due to the number, the cost and recurrence of needed investigations. Its purpose is to show congenital or hereditary immunological deficiencies, which, however, happen scarcely.

Adenoidectomy↗
PubMed1994

AIDS: human rights and responsibilities.

As epidemiology changes and new therapies emerge, the focus of disease control is shifting from the voluntary to the mandatory. This is reflected in debates about routine HIV testing of newborns and the confidentiality of HIV-infected adults. Other issues include access to unproven drugs, the problems posed by co-infection with TB, and prevention through needle and condom distribution.

AIDS Serodiagnosis↗
PubMed2004

Renal function in men with lower urinary tract symptoms at first presentation to urology out-patient department.

AIM: Current national guidelines state that it is mandatory to perform an estimation of renal function in all males with lower urinary tract symptoms (LUTS). As national audit evidence suggests this is not general practice, we have carried out a study to assess the value of routine testing of renal function in this group. PATIENTS AND METHODS: Serum creatinine or urea was measured in 213 consecutive men presenting to the urology out-patient department with lower urinary tract symptoms. Risk factors for renal dysfunction such as large post-void residual volume, proteinuria, microscopic haematuria, diabetes mellitus and cardiovascular disease were noted. RESULTS: Twelve of 213 patients had abnormal results. One 90-year-old had a raised serum urea but was found to have a normal creatinine level. Ten of the remaining 11 patients would have had their renal dysfunction predicted by history, examination or bedside tests. CONCLUSIONS: Routine measurement of creatinine or urea in men presenting with LUTS with no other risk factors could be considered purely a health screening test. It is suggested that it should no longer be considered as mandatory, in this situation, but used only if specifically indicated. A urine flow rate would be a more useful test in reaching a diagnosis and planning treatment.

Adult↗
PubMed1999

[Evaluation of surgical risk in patients with COPD].

In this overview general risk factors for postoperative complications are discussed with special reference to pulmonary complications, which frequently occur in patients with chronic obstructive pulmonary disease (COPD). In a second part the functional evaluation of lung resection candidates is presented. Pulmonary complications are the most frequent cause of postoperative morbidity and mortality. Risk factors include: underlying respiratory disease, especially COPD, current smoking, duration of anaesthesia, type of surgical procedure (upper abdominal or thoracic surgery), age and obesity. The preoperative evaluation of patients at risk is discussed. For non-thoracic surgery preoperative pulmonary function testing and a preoperative chest radiograph are indicated for high-risk patients only, whereas they are mandatory for all lung resection candidates. There are no cut-off values in pulmonary function testing which would preclude non-thoracic surgical procedures. In patients with COPD, laparascopic procedures are recommended; and regional or epidural anaesthesia have less adverse effects on pulmonary function than general anaesthesia. Prevention of postoperative pulmonary complications includes smoking cessation at least eight weeks before surgery, and, if indicated preoperative treatment with antibiotics, beta2-agonists, steroids (steroid-trial) and intensive perioperative chest physiotherapy (incentive spirometry). The functional reserves of lung resection candidates is assessed with an algorithm based on the forced expiratory volume in one second (FEV1), the transfer factor of the lung for carbon monoxide (DLCO), and the maximal oxygen uptake on exercise (VO2max). In critical patients additional split function studies are necessary to estimate the remaining pulmonary function depending on the extent of resection.

Health Status Indicators↗
PubMed2005

Pressure-regulated volume control ventilation vs synchronized intermittent mandatory ventilation for very low-birth-weight infants: a randomized controlled trial.

OBJECTIVE: To test the hypothesis that pressure-regulated volume control (PRVC), an assist/control mode of ventilation, would increase the proportion of very low-birth-weight infants who were alive and extubated at 14 days of age as compared with synchronized intermittent mandatory ventilation (SIMV). STUDY DESIGN: Ventilated infants with birth weight of 500 to 1249 g were randomized at less than 6 hours of age either to pressure-limited SIMV or to PRVC on the Servo 300 ventilator (Siemens Electromedical Group, Danvers, Mass). Infants received their assigned mode of ventilation until extubation, death, or meeting predetermined failure criteria. RESULTS: Mean +/- SD birth weights were similar in the SIMV (888 +/- 199 g, n = 108) and PRVC (884 +/- 203 g, n = 104) groups. No differences were detected between SIMV and PRVC groups in the proportion of infants alive and extubated at 14 days (41% vs 37%, respectively), length of mechanical ventilation in survivors (median, 24 days vs 33 days, respectively), or the proportion of infants alive without a supplemental oxygen requirement at 36 weeks' postmenstrual age (57% vs 63%, respectively). More infants receiving SIMV (33%) failed their assigned ventilator mode than did infants receiving PRVC (20%). Including failure as an adverse outcome did not alter the overall outcome (39% of infants in the SIMV group vs 35% of infants in the PRVC group were alive, extubated, and had not failed at 14 days). CONCLUSION: In mechanically ventilated infants with birth weights of 500 to 1249 g, using PRVC ventilation from birth did not alter time to extubation.

Apgar Score↗