Hyperemesis Gravidarum in Undiagnosed Gitelman's Syndrome.

Introduction. Gitelman's syndrome (GS) is an autosomal recessive inherited defect in the thiazide-sensitive sodium-chloride cotransporter (NCCT) in the renal distal convoluted tubule. Physiologic changes of pregnancy promote renal potassium wasting, but serum potassium levels are kept in the physiologic range by increased levels of progesterone, which resist kaliuresis.

Use of a Comprehensive Program to Reduce the Incidence of Hospital-Acquired Pressure Ulcers in an Intensive Care Unit.

Background: Hospital-acquired pressure ulcers (HAPUs) are a costly and largely preventable complication occurring in a variety of acute care settings. Because they are considered preventable, stage III and IV HAPUs are not reimbursed by Medicare.

Objectives: To assess the effectiveness of a formal, year-long HAPU prevention program in an adult intensive care unit, with a goal of achieving at least a 50% reduction in 2013, compared with 2011.

An intra-abdominal abscess or "rind" as a consequence of peritoneal dialysis-associated pseudomonas peritonitis.

Background: Abdominal CT imaging has defined characteristics of two pathological entities specific to peritoneal dialysis patients. Both are associated with serious peritoneal complications. One is comprised of ascites accompanied by septation and loculated fluid pockets as a complication of bacterial peritonitis.

Innovative surveillance methods for rapid detection of disease outbreaks and bioterrorism: results of an interagency workshop on health indicator surveillance.

A system designed to rapidly identify an infectious disease outbreak or bioterrorism attack and provide important demographic and geographic information is lacking in most health departments nationwide. The Department of Defense Global Emerging Infections System sponsored a meeting and workshop in May 2000 in which participants discussed prototype systems and developed recommendations for new surveillance systems. The authors provide a summary of the group's findings, including expectations and recommendations for new surveillance systems.

Advances in medical biological defense technology.

No single medical countermeasure will meet the needs for defense against all biological threats in all possible scenarios (civilian, military, clinical, and environmental). As the threat of genetically engineered organisms rises and the risk increases that these organisms might escape detection and successful treatment, it will be necessary to use advances in bioengineering to combat these new threats. This article presents several novel approaches taken by the DoD in collaboration with industry partners and other federal laboratories to produce improved biowarfare vaccines, diagnostics, and treatments.

A field-expedient algorithmic approach to the clinical management of chemical and biological casualties.

Warriors on the modern battlefield face considerable danger from possible attack with chemical and biological weapons. Aggravating this danger is the fact that medical resources at the lowest echelons of care, already likely to be strained to capacity during modern conventional combat, are at present inadequate to handle large numbers of chemical or biological casualties. Complicating this problem further is the austere nature of diagnostic modalities available at lower echelons.

Immunization against potential biological warfare agents.

The intentional release of biological agents by belligerents or terrorists is a possibility that has recently attracted increased attention. Law enforcement agencies, military planners, public health officials, and clinicians are gaining an increasing awareness of this potential threat. From a military perspective, an important component of the protective pre-exposure armamentarium against this threat is immunization.

Glomerulopathies with fibrillary deposits.

Renal diseases involving glomerular deposits of fibrillary material are an important diagnostic challenge for the ultrastructural pathologist. Two primary disorders of this type, termed "fibrillary glomerulonephritis" (characterized by fibrils measuring approximately 20 nm in diameter) and "immunotactoid glomerulopathy" (characterized by larger, microtubular deposits), have been described. The possible relatedness of these two disorders and their potential association with other systemic illnesses are subjects of current debate.

Task performance in virtual environments used for cognitive rehabilitation after traumatic brain injury.

Objective: This report describes a reliability study using a prototype computer-simulated virtual environment to assess basic daily living skills in a sample of persons with traumatic brain injury (TBI). The benefits of using virtual reality in training for situations where safety is a factor have been established in defense and industry, but have not been demonstrated in rehabilitation.

Subjects: Thirty subjects with TBI receiving comprehensive rehabilitation services at a residential facility.

Biochemical effects of oral sodium phosphate.

Our objective was to monitor serum and urine biochemical changes after oral sodium phosphate cleansing in a prospectively designed study. The study subjects were seven healthy, asymptomatic adults. Sodium phosphate 45 ml diluted in 45 ml water was given orally at baseline and 12 hr later.

Frequency of complications with prolonged femoral vein catheterization for hemodialysis access.

Analysis of 120 cases of femoral vein catheterization for > or = 2 days for hemodialysis in 89 hospitalized patients was performed to determine the frequency of catheter-related complications including infection and venous thrombosis. The rate of clinically significant complications was < 3.5% and compared favorably with published complication rates of central vein catheters.

Sweet taste (dysgeusia). The first symptom of hyponatremia in small cell carcinoma of the lung.

Three patients with small cell carcinoma of the lung presented with a persistent unpleasant sweet taste as their initial and only symptom. On further evaluation, they were found to have hyponatremia secondary to the syndrome of inappropriate secretion of antidiuretic hormone. In each case, resolution of the sweet taste paralleled an increase in serum sodium concentration after water restriction alone.

Hypertonic saline: patterns of and guidelines for use.

Guidelines for appropriate use of hypertonic (3%) saline (HS) for the treatment of hyponatremia are ill-defined. We reviewed each infusion of HS in a 400-bed university hospital over a 1-year period. Of the 14 infusions, the hyponatremia (average serum sodium [Na+] 19.

Clearance of 131I by hemodialysis.

There are no available data documenting the dialysis clearance of iodide in humans. This work quantitates the hemodialysis clearance of iodide (as 131I) over time and examines certain factors which influence that clearance. In a single-patient study, three dialysis periods were studied over the 24 to 96 hours following administration of 129 mCi 131I given as Na131I.

Remnant kidney oxygen consumption: hypermetabolism or hyperbole?

On the basis of observations in surgically created remnant kidneys of rat and dog, a novel hypothesis for progressive injury in the setting of reduced renal mass has been put forth. Both rat and dog remnant kidneys exhibit significant hypertrophy that is accompanied by an increased rate of oxygen consumption (QO2) per remaining nephron but not per gram of tissue. This putative "hypermetabolism" is seen in the face of progressive scarring of the tubulointerstitial compartment of the remnant kidney, and interventions that reduce QO2 in these models have been associated with reduced tissue injury in previous studies.

Case report: a novel form of free protein S deficiency in an HIV-positive patient on hemodialysis.

Investigation of repetitive thrombotic episodes in an HIV-positive patient on maintenance hemodialysis revealed extraordinarily high levels of total (free plus protein bound) protein S antigen but severe reductions in free (interactive) protein S antigen. Patients with the nephrotic syndrome or chronic renal failure have shown elevations of total protein S antigen, associated with increased levels of the specific C4b-binding protein, yet have had normal free protein S antigen levels. Based on the fall in total and free protein S levels during hemodialysis treatments, the presence of normal levels of C4b-binding protein, and the coexistence of a polyclonal gammopathy, the authors infer the presence of a unique protein that binds protein S in this patient and that is not apparent in normal plasma.

Natural history of the eosinophilia-myalgia syndrome.

Objective: To describe the natural history and disease progression of the eosinophilia-myalgia syndrome and to assess the therapeutic effects of orally administered steroids on the disorder as of October 1990.

Design: Case-series analysis. A cohort of 45 patients with the eosinophilia-myalgia syndrome was followed prospectively by periodic telephone interviews and medical examinations for an average of 14 months after onset of illness.

Measurement of intracellular pH in suspensions of renal tubules from potassium-depleted rats.

Intracellular pH was estimated from the fluorescence of 2',7'-bis(carboxyethyl)-5,6-carboxyfluorescein (BCECF) in isolated renal cortical tubules from control, potassium-depleted (KD) and NH4Cl-induced metabolic acidosis (MA) rats. While pHi was not different among control, short- and long-term KD, and NH4Cl MA rats, in vitro rates of ammonium production were increased in rats with metabolic acidosis and both short- and long-term potassium depletion. Mitochondrial matrix pH, and the pH gradient across the mitochondrial membrane were not different in tubules from KD rats compared to those from controls.

Severe hyponatremia in spinal cord injury.

A male quadriplegic (C6--complete) with persistent chronic hyponatremia (serum sodium values ranging consistently from 117-132 mmol/L) developed acute hyponatremia with a serum sodium concentration of 98 mmol/L. This extreme hyponatremia related, in part, to a reversible defect in the excretion of a water load, while on a low (46 mmol/day) sodium diet. Subsequent ingestion of a normal sodium diet (150 mmol/day), with or without 0.

The pK'1 of the carbonic acid-bicarbonate buffer system in hemodialyzed patients.

Blood gas analysis is crucial for the proper evaluation of systemic acid-base disorders, but several reports have been critical of the current approach which relies on the Henderson-Hasselbalch equation and other possibly erroneous assumptions about the bicarbonate-carbonic acid buffer system of blood. This report studied renal failure patients receiving dialysis and nondialyzed medical patients with respect to variations of the pK'1 of carbonic acid dissociation and discrepancies between measured and calculated bicarbonate. Among dialyzed patients, the mean pK'1 differed significantly from 6.

Proton compartmentation in rat renal cortical tubules.

To study the control of renal ammoniagenesis, a technique was developed to estimate simultaneously intracellular (pHi) and intramitochondrial (pHm) pH in suspensions of rat renal cortical tubules. pHi was estimated with the fluorescent probe 2',7'biscarboxyethyl-5(6)-carboxy-fluorescein (BCECF). The intracellular distribution of the weak acid 5,5-dimethyloxazolidine-2,4-dione (DMO) allowed calculation of pHm with the use of values of pHi obtained with BCECF and tubule mitochondrial content.