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Background Diagnosis of the HIV-associated lipodystrophy syndrome is based on clinical assessment, in lack of a consensus about case definition and reference methods. Three bedside methods were compared in their diagnostic value for lipodystrophy. Patients and Methods. Consecutive HIV-infected outpatients (n = 278) were investigated, 128 of which also had data from 1997 available. Segmental bioelectrical impedance analysis (BIA) and waist, hip and thigh circumferences were performed. Changes in seven body regions were rated by physicians and patients using linear analogue scale assessment (LASA). Diagnostic cut-off values were searched by receiver operator characteristics. Results. Lipodystrophy was diagnosed in 85 patients (31%). BIA demonstrated higher fat-free mass in patients with lipodystrophy but not after controlling for body mass index and sex. Segmental BIA was not superior to whole body BIA in detecting lipodystrophy. Fat-free mass increased from 1997 to 1999 independent from lipodystrophy. Waist-hip and waist-thigh ratios were higher in patients with lipodystrophy. BIA, anthropometry and LASA did not provide sufficient diagnostic cut-off values for lipodystrophy. Agreement between methods, and between patient and physician rating, was poor. Conclusion: These methods do not fulfil the urgent need for quantitative diagnostic tools for lipodystrophy. BIA estimates of fat free mass may be biased by lipodystrophy, indicating a need for re-calibration in HIV infected populations. (C) 2001 Harcourt Publishers Ltd.

Abstract-Objective: Bioelectrical impedance analysis (BIA) is widely used as bedside assessment of body composition. Body cell mass (BCM) and intracellular water (ICW) are clinically important body compartments. Estimates of ICW obtained from BIA by different calculation approaches were compared to a reference method in male HIV-infected patients. Patients: Representative subsample of clinically stable HIV-infected outpatients, consisting of 42 men with a body mass index of 22.4 +/- 3.8 kg/m(2) (range, 13-31 kg/m(2)). Methods: Total body potassium was assessed in a whole body counter, and compared to 50 kHz mono-frequency BIA and multifrequency bioelectrical impedance spectroscopy. Six different prediction equations for ICW from BIA data were applied. Methods were compared by the Bland-Altman method. Results: BIA-derived ICW estimates explained 58% to 73% of the observed variance in ICW (TBK), but limits of confidence were wide (-16.6 to +18.2% for the best method). BIA overestimated low ICW (TBK) and underestimated high ICW (TBK) when normalized for weight or height. Mono- and multifrequency BIA were not different in precision but population-specific equations tended to narrower confidence limits. Conclusion: BIA is an unreliable method to estimate ICW in this population, in contrast to the better established estimation of total body water and extracellular water. Potassium depletion in severe malnutrition may contribute to this finding but a major part of the residual between methods remains unexplained. (C) 2000 Harcourt Publishers Ltd.

To compare nutritional counseling with and without oral supplements in HIV-infected patients with recent weight loss.Randomized non-blinded controlled trial, stratified for change in antiretroviral treatment at baseline.HIV-infected patients with recent weight loss (5% of total, and3% in the last month).Nutritional counseling to increase dietary intake by 600 kcal/day over 8 weeks; in group A (n=24) by normal food, and in group B (n=26) by a range of fortified drink supplements with a calorific value of 0.6 to 1.5 kcal/ml.Body composition by bioelectrical impedance analysis, dietary intake by 24 h recall.Fat free mass increased from baseline to week 8 (P0.05) with no difference between groups A and B (P=0.97). Body cell mass and weight gain were not significant and equal between groups. Assessed at weeks 2 and 4, group B patients consumed 11 +/- 6 kcal/kg as supplements, and their total energy intake was 6 kcal/kg higher than in group A (P0.01). Total energy intake was not different between groups at weeks 6 and 8.Nutritional counseling and oral supplements are both feasible methods to restore food energy intake in malnourished HIV-infected patients. Although normal food intake is partially replaced, oral supplements may improve the adherence to a weight gain regimen.

The main aim of percutaneous nucleotomy techniques is to reduce the volume and pressure of the affected disc while leaving all other structures unaffected. Previously percutaneous discectomies were performed under fluoroscopic guidance with or without endoscopy. In this paper we describe the combination of CT-scanning and fluoroscopy for guidance of nucleo-tomes, lasers, microendoscopes and other microinstmments. The results of percutaneous laser nucleotomy performed on 116 out-patients with chronic back pain are reported. Immediate pain relief was obtained in 92% of the patients, and improvement of neurological deficits in 59%. After 6 weeks, 87% of patients were back at work. At follow-up, 1–17 months later, overall improvement of pain symptoms of 50–100% was present in 81% of the patients; the results were better in patients with longer follow-up times. Spon-dylodiscitis occurred in one patient and a second herniation with re-operation in five patients. These results show that effective treatment of di...

Vasopressin stimulates calcium signaling and chloride-dependent depolarization in glomerular mesangial cells. We describe a technique whereby both calcium and membrane potential changes can be simultaneously monitored with fluorescent probes. This technique was validated by comparison with single parameter measurements in basal and vasopressin-stimulated mesangial cells. It was shown that the calibration for calcium is unaffected by that for membrane potential, whereas the calibration for membrane potential is affected by prior calcium calibration. Accordingly, it was necessary to calibrate for the former first. The technique was then applied to investigate the effects of endothelin, which was found to elicit a concentration-dependent calcium release response and a chloride-dependent depolarization of mesangial cells. The interaction between the calcium signaling response to vasopressin and endothelin was also investigated. When vasopressin stimulation occurred subsequent to endothelin stimulation, and vice versa, a calcium response was still evident. However, these agonists displayed partial heterologous desensitization in that prior stimulation with vasopressin attenuated the subsequent response to endothelin, and vice versa. This suggests the presence of functionally distinct hormone-responsive calcium pools. The technique of double-parameter fluorescent measurement outlined could potentially be applied to other cellular signaling parameters by the use of the appropriate probes.

To review the literature assessing current trends within primary health care and its delivery and the role of the chiropractic primary care physician.Select papers which offer definitions of primary care.Several influential papers offer criteria necessary to be considered primary care practitioners.Primary care is comprehensive, coordinated, continuous and accessible. Chiropractic care meets this definition.The primary care chiropractic physician is a viable and important part of the primary health care delivery system, with many chiropractic physicians currently prepared to participate effectively and competently in primary care.

The implementation of an expanded surveillance system of healthcare-associated infections (HAIs) at institutional level is necessary since these events can occur outside of intensive care units. In addition, this comprehensive information allows evaluating the impact of the Prevention and Control Infection Program (PCIP) in terms of reduction of HAIs.

A case of symmetrical neurofibroma with onion bulbs in various stages of development and progression to microneurinomas is presented. Immunohistochemistry with differentiation and growth factor markers as well as electron microscopy showed a Schwann cell origin of the concentrically arranged cells. The onion bulbs differed from those of hypertrophic neuropathy by their more compact structure. A partial expression of cellular proliferation markers in the onion bulbs was consistent with a multifocal proliferative activity, confirming the neoplastic nature of the lesion.

EDITOR,—In 1992 the Department of Health recommended that all women should take folic acid supplements around the time of conception to reduce the incidence of neural tube defects.1 We undertook a survey of antenatal patients and those trying to conceive who attended our surgery in May and June 1994 to determine whether this advice was being followed. Of the 109 pregnant women surveyed, only 20 had taken supplements in accordance with the recommendations. In a further five cases the pregnancies were unplanned; …

Zur zytostatischen Behandlung von Weichteilsarkomen oder malignen Mesotheliomen wurde ein modifiziertes CYVADIC-Protokoll ver-wendet. Zur besseren Knochenmarkregeneration wurde das Intervall von urspr

Mesangial cells are smooth muscle-like cells of the renal glomerulus which contract and produce prostaglandins in response to vasopressin and angiotensin. These responses serve to regulate the glomerular capillary filtering surface area. We have used the membrane potential-sensitive fluorescent dye bis-oxonol and the intracellular fluorescent calcium-sensitive probe Indo-1 to study the changes in membrane potential (Em) and intracellular free calcium concentration ([Ca2+]i) in cultured rat mesangial cells in response to vasoconstrictor hormones. Basal [Ca2+]i was 227 +/- 4 nM, and stimulation by maximal concentrations of either vasopressin or angiotensin resulted in a transient 4-6-fold rise. Resting membrane potential was 45.8 +/- 0.9 mV and vasoconstrictor hormones caused a depolarization of 14-18 mV. The following extracellular ion substitutions indicated that chloride efflux was the predominant ion flux responsible for depolarization: 1) depolarization persisted when sodium in the medium was substituted with N-methylglucamine; 2) substitution of medium sodium chloride with sodium gluconate, which enhances the gradient for chloride efflux, augmented vasoconstrictor-stimulated depolarization; 3) suspension of cells in potassium chloride medium resulted in depolarization, following which, stimulation by either vasopressin or angiotensin resulted in hyperpolarization; and 4) this hyperpolarization did not occur when potassium gluconate medium was used to depolarize the cells. The calcium ionophore ionomycin also resulted in membrane depolarization. However, prevention of the rise in [Ca2+]i by prior exposure to ionomycin in calcium-free medium or by loading mesangial cells with the intracellular calcium buffer BAPTA did not abrogate the depolarization response to vasoconstrictor hormones. This indicates that a rise in intracellular calcium is not necessary for depolarization. In contrast, prior depolarization of the cells using varying concentrations of KCl in the external medium, which dissipated the electrochemical gradient for chloride efflux, resulted in a corresponding prolongation of the transient calcium response to vasopressin and angiotensin. These findings indicate that angiotensin and vasopressin depolarize mesangial cells by activating chloride channels and that this activation can occur by both calcium-dependent and -independent mechanisms. In addition, activation of chloride channels with resulting depolarization may serve to modulate the calcium signal.

A 20-year-old man suffering from Crohn's disease developed coma and generalized seizures following ileocecal resection. During postoperative parenteral feeding he received xylitol in an unusually high concentration. CT examinations a few days before death showed intense hypodensity and swelling of brainstem and basal ganglia and increasing triventricular dilatation. Autopsy revealed, mainly in the brainstem and cerebellum, a destruction of intracerebral, intracerebellar and leptomeningeal vessel walls by birefringent crystals (probably calcium oxalate), an early inflammatory reaction and severe brain edema with final tonsillar herniation. The same crystalloid deposits were found in the kidneys.

Receptors for atrial natriuretic peptide (ANP) have been demonstrated in renal mesangial cells as well as other cell types in the glomerulus. The biochemical basis for the effects of ANP on glomerular hemodynamics remains undefined. Using cultured rat glomerular mesangial cells, we demonstrated a concentration-dependent stimulation of cGMP production in intact cells, and of guanylate cyclase in membranes. Despite the presence of a guanylate cyclase response, ANP had no inhibitory effect on basal inositol trisphosphate production nor on basal cytosolic calcium. Arginine vasopressin stimulated IP 3 production, caused a rise in cytosolic calcium as measured using the calcium-sensitive fluorescent probe Indo-1, and caused mesangial cell contraction. ANP caused a slight but significant enhancement of vasopressin-stimulated IP 3 production, but had no effect on the cytosolic calcium response nor on the contractile response. 8-Bromoc GMP likewise had no effect on the generation of the calcium signal. These results indicate that the effects of ANP on glomerular hemodynamics are not mediated by an alteration in the generation of the calcium signal in mesangial cells. In contrast, addition of calcium inhibited ANP stimulated guanylate cyclase activity.

Specific desensitization of adrenergic receptors has been reported by several investigators (c.f. Wolfe et al. Ann.Pharmacol.Toxicol. 17, 575, 1977). It has been, therefore, investigated, whether adrenergic β-receptors in immature red blood cells from rats (after pretreatment with acetylphenylhydrazine 3 × 40 mg/kg) could be desensitized by treatment of the animals with high doses of (±) isoprenaline (Ipn; 4 × 30 mg/kg within 24 hours before decapitation). cAMP synthesis was measured in suspensions of intact cells or in membrane preparations; receptor density was determined using 3H (−)-dihydroalprenolol (DHAP).

Accurate surveillance definitions are necessary to evaluate the impact of interventions to prevent central line–associated bloodstream infections (CLABSIs). Although, the National Healthcare Safety Network (NHSN) definition for CLABSI has been applied extensively in intensive care units, few studies have examined its performance among bone marrow transplant (BMT) recipients. As those patients have inherent risks for bloodstream infections associated with mucosal barrier injury, more specific definitions are necessary for catheter-related bloodstream infection (CRBSI) in order to determine the impact of improvement projects to decrease these device-associated infections (DAIs).