RESUMEN
Urinary magnesium and pH are known to modulate urinary calcium excretion, but the mechanisms underlying these relationships are unknown. In this study, the data from 17 clinical trials in which urinary magnesium and pH were pharmacologically manipulated were analyzed, and it was found that the change in urinary calcium excretion is directly proportional to the change in magnesium excretion and inversely proportional to the change in urine pH; a regression equation was generated to relate these variables (R(2) = 0.58). For further exploration of these relationships, intravenous calcium chloride, magnesium chloride, or vehicle was administered to rats. Magnesium infusion significantly increased urinary calcium excretion (normalized to urinary creatinine), but calcium infusion did not affect magnesium excretion. Parathyroidectomy did not prevent this magnesium-induced hypercalciuria. The effect of magnesium loading on calciuria was still observed after treatment with furosemide, which disrupts calcium and magnesium absorption in the thick ascending limb, suggesting that the effect may be mediated by the distal nephron. The calcium channel TRPV5, normally present in the distal tubule, was expressed in Xenopus oocytes. Calcium uptake by TRPV5 was directly inhibited by magnesium and low pH. In summary, these data are compatible with the hypothesis that urinary magnesium directly inhibits renal calcium absorption, which can be negated by high luminal pH, and that this regulation likely takes place in the distal tubule.
Asunto(s)
Calcio/orina , Magnesio/orina , Animales , Ensayos Clínicos como Asunto , Humanos , Concentración de Iones de Hidrógeno , Oocitos/metabolismo , Ratas , Ratas Sprague-Dawley , Estudios Retrospectivos , Xenopus laevisRESUMEN
BACKGROUND: This study was designed to determine the prevalence of high levels of posttraumatic stress disorder (PTSD) symptoms among pediatric orthopaedic trauma patients recovering from injury and to see whether injury or demographic variables are associated with the presence of the symptoms. METHODS: Four hundred pediatric orthopaedic trauma patients completed the Child PTSD Symptom Scale questionnaire. Demographic and injury variables were tested to see if any were associated with the presence of high levels of posttraumatic stress symptoms. RESULTS: The average age of respondents was 11 years. The average time since injury was 36 days. The mean Injury Severity Score and summed Extremity Abbreviated Injury Score were 4 and 2, respectively. A total of 130 (33%) met criteria for high levels of PTSD symptoms. None of the variables tested were associated with high levels of PTSD symptoms, except one. Patients admitted to the hospital after injury were significantly more likely to develop high levels of PTSD symptoms. CONCLUSIONS: High levels of posttraumatic stress disorder symptoms are common in the recovery period after pediatric orthopaedic trauma, even among patients with relatively minor injury. Children admitted to the hospital after injury are at higher risk for such symptoms.
Asunto(s)
Fracturas Óseas/epidemiología , Fracturas Óseas/terapia , Hospitalización/estadística & datos numéricos , Medición de Riesgo/métodos , Trastornos por Estrés Postraumático/epidemiología , Adolescente , Adulto , Causalidad , Niño , Comorbilidad , Femenino , Fracturas Óseas/psicología , Humanos , Masculino , Prevalencia , Recuperación de la Función , Factores de Riesgo , Trastornos por Estrés Postraumático/psicología , Texas/epidemiología , Índices de Gravedad del Trauma , Resultado del TratamientoRESUMEN
In this study, we determined the extent of variation in proliferative markers and hormone receptor status in breast carcinoma between core biopsies and subsequent resections, and determined the impact of clinical and histologic parameters on such variation. We performed a paired comparison of biomarkers in 87 core biopsies and subsequent resections of breast carcinomas in patients with and without preoperative chemotherapy. The markers included estrogen receptor, progesterone receptor, Her2/neu, DNA ploidy (diploidy versus nondiploidy), DNA index (difference of > or = 0.5), and MIB1 labeling index (<15% vs. >15%). The tumor biomarkers were evaluated with standard IHC and scored by automated cellular imaging systems. The number of patients showing prominent changes were as follows: ploidy, 12; DI, 15; ER, 6; PR, 15; MIB1, 17; and Her2/neu, 15. Seventeen of 87 patients sustained a significant change in MIB1 index (above or below 15%). The patients who received chemotherapy had a larger proportion with a change in MIB1 status (P < 0.05). DI showed a similar trend, although it was not statistically significant. Of the patients with MIB1 values higher in biopsy specimens, a majority showed values to decrease below 15%. MIB1 index reduction by greater than 25% was seen in 8 of 16 (50%) cases with chemotherapy, compared with only 3 of 32 (9%) without chemotherapy. MIB1 and DNA index values postchemotherapy can be a useful measure of chemoresponse. Our study underscores the need to perform prognostic markers on both biopsy and subsequent resections, especially in the setting of preoperative chemotherapy.
Asunto(s)
Neoplasias de la Mama/diagnóstico , Carcinoma/diagnóstico , Antígeno Ki-67/análisis , Biopsia con Aguja Fina , Mama/patología , Neoplasias de la Mama/terapia , Carcinoma/terapia , Proliferación Celular , ADN de Neoplasias/análisis , Diploidia , Resistencia a Antineoplásicos , Femenino , Humanos , Pronóstico , Receptor ErbB-2/análisisRESUMEN
BACKGROUND AND PURPOSE: Our previous model of spinal cord injury (SCI) included six dogs undergoing 30-minute compression with a balloon in the subarachnoid space. We determined whether various balloon sizes and compression times creates a gradation of injuries. METHODS: In 17 dogs (including our original six), angioplasty balloons 2, 4, or 7 mm in diameter (2 cm long) were inflated at T6 for 30, 120, or 240 minutes. T1- and T2-weighted, gadolinium-enhanced, and short-tau inversion recovery (STIR) MR images were obtained at 1.5 T. Spinal canal occlusion (SCO) was measured as balloon area-spinal cord area. Hematoxylin-eosin and beta amyloid precursor protein staining were performed to demonstrate hemorrhage and axonal injury, respectively. Injuries were scored as mild, moderate, or severe. Trends were assessed with one-way analysis of variance. RESULTS: SCO was 12.5-20% for 2-mm balloons, 28-56% for 4 mm, and 62-82% for 7 mm. No abnormalities were seen with SCO <30%. T1- and T2-weighted images had the poorest diagnostic performance; STIR images were best for predicting hemorrhage and axonal injury. Hemorrhage was demonstrated more frequently than was axonal injury. SCO (P < .0001) and hemorrhage (P = .002) significantly increased with balloon size. Longer inflation times tended to increase injuries for a given size, but differences were not significant. CONCLUSION: Compression injuries depended on the level of SCO. The compression times tested had less effect than the degree of compression. The value of 1.5-T MR imaging varied with the sequence and improved with contrast enhancement. STIR images showed SCIs not otherwise detected.
Asunto(s)
Angioplastia de Balón/efectos adversos , Modelos Animales de Enfermedad , Imagen por Resonancia Magnética , Compresión de la Médula Espinal/diagnóstico , Compresión de la Médula Espinal/etiología , Angioplastia de Balón/instrumentación , Animales , Medios de Contraste , Perros , Diseño de Equipo , Masculino , Índice de Severidad de la Enfermedad , Compresión de la Médula Espinal/metabolismo , Compresión de la Médula Espinal/patología , Coloración y EtiquetadoRESUMEN
BACKGROUND: Preclinical data suggests that VEGF and COX-2 are potentially important mediators in the pathogenesis of small cell lung cancer (SCLC). Little is known about the frequency of tumor expression of VEGF and COX-2 in SCLC or the prognostic significance of this expression. MATERIALS AND METHODS: Clinical records from 54 cases of SCLC were reviewed. Immunohistochemical stains for VEGF and COX-2 were performed on all tumor specimens. RESULTS: Tumor VEGF expression was detected in 43 cases (81%) and COX-2 expression in 11 (20%). No significant association between VEGF or COX-2 expression and survival was observed. CONCLUSION: This is the first study to assess the frequency and clinical significance of tumor VEGF and COX-2 expression in a large group of patients with SCLC. In this cohort, neither VEGF nor COX-2 expression impacted survival. The frequency of VEGF expression suggests that it merits further investigation as a therapeutic target in SCLC.
Asunto(s)
Carcinoma de Células Pequeñas/metabolismo , Isoenzimas/biosíntesis , Neoplasias Pulmonares/metabolismo , Prostaglandina-Endoperóxido Sintasas/biosíntesis , Factor A de Crecimiento Endotelial Vascular/biosíntesis , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Pequeñas/tratamiento farmacológico , Carcinoma de Células Pequeñas/enzimología , Carcinoma de Células Pequeñas/patología , Cisplatino/administración & dosificación , Estudios de Cohortes , Ciclooxigenasa 2 , Etopósido/administración & dosificación , Femenino , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/enzimología , Neoplasias Pulmonares/patología , Masculino , Proteínas de la Membrana , Persona de Mediana Edad , Estadificación de Neoplasias , PronósticoRESUMEN
BACKGROUND: The purpose of this study was to determine the prevalence of posttraumatic stress disorder among patients seen following an orthopaedic traumatic injury and to identify whether injury-related or demographic variables are associated with the disorder. METHODS: Five hundred and eighty patients who had sustained orthopaedic trauma completed a Revised Civilian Mississippi Scale for Posttraumatic Stress Disorder questionnaire. Demographic and injury data were collected to analyze potential variables associated with posttraumatic stress disorder. RESULTS: Two hundred and ninety-five respondents (51%) met the criteria for the diagnosis of posttraumatic stress disorder. Patients with posttraumatic stress disorder had significantly higher Injury Severity Scores (p = 0.04), a higher sum of Extremity Abbreviated Injury Scores (p = 0.05), and a longer duration since the injury than those without posttraumatic stress disorder (p < 0.01). However, none of these three variables demonstrated a good or excellent ability to discriminate between patients who had posttraumatic stress disorder and those who did not. The response to the item, "The emotional problems caused by the injury have been more difficult than the physical problems," was significantly associated with the presence of posttraumatic stress disorder (p < 0.0001) and showed a fair ability to identify patients with the disorder. CONCLUSIONS: Posttraumatic stress disorder is common after orthopaedic trauma. Patients who respond positively to the item, "The emotional problems caused by the injury have been more difficult than the physical problems," may meet diagnostic criteria for this disorder and should be evaluated further.
Asunto(s)
Fracturas Óseas/psicología , Trastornos por Estrés Postraumático/etiología , Adulto , Nivel de Alerta , Reacción de Prevención , Femenino , Humanos , Masculino , Prevalencia , Estudios Prospectivos , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/epidemiología , Encuestas y Cuestionarios , Factores de Tiempo , Índices de Gravedad del TraumaRESUMEN
Fifty-one male patients with prior pelvic fracture completed a Brief Sexual Function Inventory questionnaire (BSFI) 2 years postinjury. Responses were compared to those of 53 men with ankle fractures. Patients with pelvic fracture scored significantly worse than patients with ankle fracture. Patients with pelvic fracture scored poorly on sex drive, erection, ejaculation, and satisfaction with sex life. Older patients had significantly worse sex function scores than younger patients. Sexual dysfunction is common after pelvic fracture, and many facets of sex life are affected. The BSFI was well accepted, and is a useful screening tool for identifying patients with sexual dysfunction.
Asunto(s)
Fracturas Óseas/fisiopatología , Huesos Pélvicos/lesiones , Conducta Sexual/fisiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Traumatismos del Tobillo/fisiopatología , Eyaculación/fisiología , Fracturas Óseas/complicaciones , Humanos , Libido/fisiología , Masculino , Persona de Mediana Edad , Erección Peniana/fisiología , Disfunciones Sexuales Fisiológicas/etiología , Encuestas y CuestionariosRESUMEN
BACKGROUND: Immunosuppression is a consequence of allogeneic (homologous) blood transfusion (ABT) in humans and is associated with an increased risk in cancer recurrence rates after potentially curative surgery as well as an increase in the frequency of postoperative bacterial infections. Although a meta-analysis has been reported demonstrating the relationship between ABT and colon cancer recurrence, no meta-analysis has been reported demonstrating the relationship of ABT to postoperative bacterial infection. METHODS: Twenty peer-reviewed articles published from 1986 to 2000 were included in a meta-analysis. Criteria for inclusion included a clearly defined control group (nontransfused) compared with a treated (transfused) group and statistical analysis of accumulated data that included stepwise multivariate logistic regression analysis. In addition, a subgroup of publications that included only the traumatically injured patient was included in a separate meta-analysis. A fixed effects analysis was conducted with odds ratios obtained by using the conditional maximum likelihood method and 95% confidence intervals on the obtained odds ratios were determined using the mid-p technique. RESULTS: The total number of subjects included in this meta-analysis was 13,152 (5,215 in the transfused group and 7,937 in the nontransfused group). The common odds ratio for all articles included in this meta-analysis evaluating the association of ABT to the incidence of postoperative bacterial infection was 3.45 (range, 1.43-15.15), with 17 of the 20 studies demonstrating a value of p < or = 0.05. These results provide overwhelming evidence that ABT is associated with a significantly increased risk of postoperative bacterial infection in the surgical patient. The common odds ratio of the subgroup of trauma patients was 5.263 (range, 5.03-5.43), with all studies showing a value of p < 0.05 (0.005-0.0001). These results demonstrate that ABT is associated with a greater risk of postoperative bacterial infection in the trauma patient when compared with those patients receiving ABT during or after elective surgery. CONCLUSION: These results demonstrate that ABT is an associated and apparently significant and frequently overlooked risk factor for the development of postoperative bacterial infection in the surgical patient. Allogeneic blood transfusion is a greater risk factor in the traumatically injured patient when compared with the elective surgical patient for the development of postoperative bacterial infection.
Asunto(s)
Infecciones Bacterianas/etiología , Complicaciones Posoperatorias , Reacción a la Transfusión , Humanos , Tolerancia Inmunológica , Oportunidad Relativa , Factores de Riesgo , Inmunología del Trasplante , Trasplante Homólogo , Heridas y Lesiones/complicaciones , Heridas y Lesiones/cirugíaRESUMEN
OBJECTIVE: To determine if age, fracture pattern, systolic blood pressure on arrival, base deficit, or the Revised Trauma Score is predictive of mortality, transfusion requirements, use of pelvic arteriography, later complications, or injuries associated with the pelvic ring disruption. STUDY DESIGN: Retrospective review of a prospectively collected database. METHODS: All closed pelvic ring disruptions seen between November 1, 1997 and November 30, 1999 were included. Predictive variables and outcome variables were recorded for each patient. Statistical analysis was used to determine if the above variables were predictive. RESULTS: Shock on arrival and the Revised Trauma Score were significantly associated with mortality, transfusion requirement, Injury Severity Score, and all the Abbreviated Injury Scores except the one for skin. In addition, the Revised Trauma Score was significantly associated with the use of pelvic arteriography and predicted more complications than did shock on arrival. Age was significantly associated with transfusion requirement, Injury Severity Score, the chest and skin Abbreviated Injury Scores, use of arteriography, and death. The mortality rate among patients who presented in shock was 57 percent. A Revised Trauma Score of less than 11 predicted mortality with a sensitivity and specificity of 58 percent and 92 percent, respectively. Shock on arrival predicted mortality with a sensitivity and specificity of 27 percent and 96 percent, respectively. Age greater than sixty years predicted mortality with a sensitivity and specificity of 26 percent and 91 percent, respectively. In our analysis of the fracture patterns, we were unable to demonstrate consistent, meaningful links between specific fracture classes and the outcome variables. CONCLUSIONS: Shock on arrival and the Revised Trauma Score are useful predictors of mortality and transfusion requirements, Injury Severity Score, and Abbreviated Injury Scores for the head and neck, face, chest, abdomen, and extremities. In addition, the Revised Trauma Score predicts the use of pelvic arteriography and later complications. Age predicted transfusion requirement, Injury Severity Score, the chest and skin Abbreviated Injury Scores, use of arteriography, and death.
Asunto(s)
Angiografía , Transfusión Sanguínea , Fracturas Óseas/complicaciones , Fracturas Óseas/diagnóstico por imagen , Pelvis/diagnóstico por imagen , Pelvis/lesiones , Choque/diagnóstico por imagen , Choque/etiología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Presión Sanguínea , Femenino , Fracturas Óseas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Pelvis/irrigación sanguínea , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Sensibilidad y Especificidad , Choque/mortalidad , Índices de Gravedad del TraumaRESUMEN
OBJECTIVE: To compare estimates of serum bilirubin as determined by a transcutaneous device (BiliChek [BC]) with laboratory-measured total serum bilirubin (TSB) in a predominately Hispanic population in which a significant number of TSB values > or =15 mg/dL was anticipated. METHODS: A total of 248 Hispanic and 56 non-Hispanic neonates were studied. Transcutaneous measurements were performed by 1 investigator within 30 minutes of blood sampling for TSB; TSB was determined in a large clinical laboratory using the diazo Jendrassik-Grof with blank method. Agreement between BC and TSB determinations was assessed using Bland-Altman plots and the Bradley-Blackwood test. Interdevice comparisons were made among the BC devices. Predictive indices for TSB >10 mg/dL and >15 mg/dL were determined using various BC cutoff values. RESULTS: TSB was > or =15 mg/dL in 31% of the Hispanic neonates. BC generally tended to underestimate TSB determinations, and this trend was more pronounced when TSB was >10 mg/dL. Very high sensitivities were observed only when relatively low BC cutoff values were used to predict TSB >10 mg/dL or >15 mg/L. Relatively small numbers of infants had BC values in these low ranges. CONCLUSIONS: The tendency of BC to underestimate TSB limits its usefulness in neonates with relatively high TSB. In this population, most infants would have required additional evaluation to ensure that TSB was not >10 mg/dL or >15 mg/dL. It seems that the discrepancy between this study and previous studies of BC is related to our relatively large number of TSB values > or =15 mg/dL.