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Thirty patients suffering from multiple sclerosis have been compared with 30 patients suffering from other chronic neurological diseases. The degree of disability was similar in these two groups. The patients with multiple sclerosis had experienced more episodes of severe depression both before and after the onset of neurological symptoms. The possible reasons for these episodes are discussed and it is concluded that in some patients serious affective disorder may be a presenting or complicating feature of multiple sclerosis. [ABSTRACT FROM AUTHOR]

The Functional Health Pattern (FHP) model is a categorization of 11 areas that assist in diagnosing human responses to illness and identifying risk factors for dysfunctional health. The incorporation of this model as a content organizer in a beginning medical-surgical course in a baccalaureate curriculum is presented as an effective method of familiarizing students with the application of the nursing process. This model permits the student nurse to identify FHPs (client strengths) and dysfunctional patterns (nursing diagnoses).

Ciprofloxacin is known to cause acute interstitial nephritis. We report the first case of ciprofloxacin-induced granulomatous interstitial nephritis and localized elastolysis. The patient presented with acute renal failure and skin lesions following a 14-day course of ciprofloxacin administered for cellulitis. The patient had symmetric, palm-sized, tender violaceous plaques on both axillae. The renal biopsy revealed granulomatous interstitial disease. A skin biopsy revealed an elastolytic process with histocytic infiltration and calcification. After discontinuing ciprofloxacin and starting a short course of steroid therapy, the skin lesion and renal function improved promptly. The nephritis relapsed after prednisone was discontinued and responded to a second course of steroid therapy. Ciprofloxacin, like penicillin, can cause granulomatous interstitial nephritis and elastolysis. A prolonged course of steroid therapy may be indicated in patients with ciprofloxacin-induced granulomatous interstitial nephritis to avoid early relapse.

Acquired cystic kidney disease (ACKD) is a common complication in patients treated with long-term dialysis. Previous studies performed prior to the cyclosporin A (CsA) era indicate that successful renal transplantation causes regression of ACKD. Little has been published, however, on the occurrence of ACKD in CsA-treated transplant recipients. We conducted a prospective sonographic study in 33 renal transplant recipients and 32 dialysis patients to evaluate the effect of CsA on ACKD in transplant recipients. Transplant recipients had a lower prevalence (39% vs. 56% in dialysis patients) and severity (smaller kidneys and lower cyst grades) of ACKD when compared with dialysis patients. Renal cell carcinoma was found in two dialysis patients. Using multiple regression analysis, we found that the use of CsA was significantly correlated with the presence of ACKD in transplant recipients (57% in CsA-treated vs. 8% in non-CsA-treated patients). We conclude that renal transplantation reduces the prevalence and severity of ACKD in the native kidneys; however, among transplant patients, CsA administration is associated with a greater prevalence of ACKD.

The purpose of this study was to determine the effect of intradialytic parenteral nutrition (IDPN) on the quality of life of malnourished patients with end-stage renal disease on high-efficiency and high-flux hemodialysis therapy. Patients, who met the Medicare eligibility requirements for IDPN, were asked to fill out and extensive questionnaire covering several measures of quality of life prior to initiating and again after completing four months of IDPN therapy. Although the IDPN improved serum albumin levels significantly, aside from improved sleep patterns, no significant improvements in quality of life could be demonstrated. The mortality rate of these enrolled patients was as high as 28% within 4 months. We concluded that the limited amount of nutrition delivered over the course of a short dialysis session may not be enough to appreciably change the lives of our malnourished patients.

In this report, we describe the successful utilization of an external right ventricular assist device as vascular access for hemodialysis and continuous arteriovenous hemodialysis in a critically ill patient on biventricular mechanical assist support. Utilization of the right ventricular assist device lines provided relatively easy and safe dialysis access and temporarily reduced the risks associated with the conventional vascular access techniques.

A master's-prepared nurse in an introductory role as a CNS will find the experience both challenging and rewarding. The CNS's first year is a time of self-exploration, stimulation, ambivalence, and growth, both professionally and personally. These nurses are often experienced clinicians who strive to be in positions in which they can affect a large group of patients and colleagues with both their knowledge and expertise. Stress occurs because the experienced nurse who has felt competent, confident, and comfortable in his or her previous role as a direct caregiver is now in the role of novice CNS who must learn the expectations and responsibilities of a new role, and develop a broad set of new skills. Utilizing the Dreyfus model, as applied to the nursing profession by Benner, this article will explore the transition of the nurse from experienced staff nurse to novice CNS. Enhancing and restraining factors that influence role realization, as well as effectiveness in supporting staff, to achieve optimal outcomes for patients will be identified.

Increased biocompatibility and lower cost are the two major arguments favoring routine dialyzer reprocessing. The impact of longer-term reprocessing is critical to the practical use of polysulfone membranes (PMs), because of the possibility of decreasing efficiency and performance, especially in the removal of beta 2-microglobulin (beta 2M), a protein that has been implicated in the development of dialysis-associated amyloidosis (DDA). In this study, we examine urea clearance (Kd), urea mass transfer coefficient (h0), ultrafiltration coefficient (K(uf)), and percent removal of beta 2M up to 24 uses. The study involved 11 patients on hemodialysis for 5.27 +/- 4.6 years, with a mean age of 62.5 +/- 9.7 years and average run-time treatment of 2.78 +/- 0.3 hours. PMs were tested after being reprocessed manually using bleach and formaldehyde. The efficacy of the dialyzer was examined on uses 1, 5, 10, 15, 20, and 24, and the percent removal of beta 2M was determined except in the twentieth use and corrected for ultrafiltration. The Kd obtained through 24 uses showed no significant change, although h0 was significantly increased in the fifteenth use, and K(uf) was significantly increased in the 10th and 20th use (P < 0.05). The percent removal of beta 2M increased significantly from 44.1 +/- 2.8 (mean +/- SEM) in the first use to 59.4 +/- 2.19 (P < 0.05) in the 10th use, and 62.1 +/- 4.07 and 63.1 +/- 4.27 in the 15th and 24th uses, respectively (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

This report describes an increased incidence of neurotoxic side effects secondary to isoniazid therapy in patients with end-stage renal disease. Toxicity was observed only in those patients receiving pyridoxine supplements of less than 100 mg/day. The increased sensitivity of the dialysis population to isoniazid neurotoxicity is predominantly due to abnormal metabolism of pyridoxine resulting in low serum levels of the active metabolite, pyridoxal phosphate. In addition, there is rapid clearance of pyridoxal phosphate by hemodialysis, resulting in a severer deficiency of this active metabolite. In order to prevent the neurotoxicity associated with isoniazid therapy, we recommend that 100 mg/day of pyridoxine be given as a supplement to hemodialysis patients requiring isoniazid therapy.

Treatment of cystinuria with alpha-mercaptopropionylglycine has been associated with fewer side effects than traditional therapy with D-penicillamine. In this report, we describe a patient who developed hyperlipidemia secondary to alpha-mercaptoproprionylglycine therapy. This abnormality resolved after the therapy was discontinued and did not recur with lower dose therapy. Patients treated with alpha-mercaptoproprionylglycine should be monitored closely for the development of lipid abnormalities.

Previous associations of primary hyperparathyroidism-induced hypercalcemia and medullary sponge kidney (MSK) have been reported. In this report, we describe a lactating woman MSK noted to be hypercalcemic throughout lactation, without evidence of hyperparathyroidism. After the baby was weaned, the serum calcium returned to normal. A bone biopsy performed while the patient was hypercalcemic was consistent with hyperparathyroidism, suggesting the presence of a parathyroid-like protein produced during lactation.

We evaluated the relationship between cell pH and cGMP production in cultured rat renal inner medullary collecting duct cells. The cGMP level, 21 +/- 6, was not different in control vs. alkalinized cells, 49 +/- 17 fmol/mg protein (p greater than 0.5). 10(-11) M atrial natriuretic peptide (ANF) enhanced cGMP production in alkalinized cells, 426 +/- 34 vs. 141 +/- 9*. Conversely, alkalinization inhibited 10(-4)M nitroprusside (SNP) induced cGMP formation, 29 +/- 9 vs. 332 +/- 67*. Phosphodiesterase inhibition abolished the difference in cGMP production by ANF but did not reverse the inhibitory effect of alkalinization on SNP induced cGMP production. In rat renal inner medullary collecting duct cells, cellular alkalinization plays a significant role in the regulation of guanylate cyclase mediated cGMP production. * = p less than 0.05).

The American Nurses' Association defines nursing as the diagnosis and treatment of human responses to actual and potential health problems. The process of nursing assessment and diagnosis facilitates the identification of actual and potential health problems and the organization and direction of the planning, implementation, and evaluation of nursing care in striving for optimal patient outcomes. The nursing diagnosis of ineffective airway clearance describes a problem for which many hospitalized patients are at risk because of either acute or chronic illness. Admission to the intensive care unit is often necessary to attain and maintain airway patency, and both autonomous nursing and collaborative interventions are implemented. Standards of nursing care guide professional practice and provide a method of assessing quality of care and achievement of patient outcomes. The standard of care developed for ineffective airway clearance encompasses the areas of etiology, defining characteristics, assessment criteria, process criteria, outcome criteria, and evaluation.

A recent change in many medical curricula has been the introduction of courses in the behavioural sciences. These courses, while introduced with the intention of emphasizing interpersonal and behavioural skills, have not been shown to lead to any of the changes towards which they are directed. Rather, there is evidence that students find these courses 'waffly' and boring. If the sociology component of these courses is to lead to change, then there is the need for a continuing process of evaluation and modification. In this paper we report upon one medical sociology course, its evaluation, subsequent modification and re-evaluation. Our evidence would suggest that sociology courses can lead to changed attitudes and values, but that such changes are contingent upon the overt application of relevant sociological concepts to the health care field.