Valvular heart disease. Part I: Diagnosis.

Cardiac murmurs are common. The general practitioner is often the first person to detect a murmur. These are often asymptomatic, yet may be a consequence of haemodynamically significant valve disease.

Unstable angina pectoris.

In recent years, there have been considerable advances in our understanding of the complex pathophysiology of unstable angina. A number of therapeutic options are now available. This article reviews current concepts of pathophysiology and summarises clinical features, natural history and available treatments.

Colonic sodium-potassium adenosine triphosphate subunit gene expression: ontogeny and regulation by adrenocortical steroids.

Mineralocorticoids and glucocorticoids exhibit overlapping but distinct effects on transepithelial sodium transport in the descending colon. Na,K-ATPase, the major sodium pump, has been variously reported to be regulated by one or both classes of steroids. The present studies explore the ontogeny and steroidal regulation of Na,K-ATPase alpha- and beta-subunit mRNA levels in the descending colon.

Continuous arteriovenous haemodiafiltration: optimal therapy for acute renal failure in an intensive care setting?

We report the results of continuous arteriovenous haemodiafiltration (CAVHD) treatment in 12 critically ill intensive care patients with acute renal failure (eight males, four females - mean age 60.9 years - range 47 to 76) (APACHE II score 28.8, range 18-37).

Mononuclear cell activation and decreased renal function in IgA nephropathy with crescents.

Our previous immunohistologic studies with monoclonal antibodies (mAb) showed that glomerular and interstitial accumulations of mononuclear cells (MNC) were common features of many types of proliferative glomerulonephritis, especially crescentic glomerulonephritis. The current study examined a series of patients with crescentic IgA disease, since IgA disease in general has a highly variable course and the presence of crescents is one indicator of likely progression to end-stage renal failure. We compared the intraglomerular and interstitial infiltrates within biopsies from patients with crescentic IgA nephropathy (N = 5) versus those with noncrescentic IgA (N = 18), or normal controls (N = 10).

Renal norepinephrine spillover and baroreflex responses in evolving heart failure.

Renal sympathetic nerve activity (RSNA), as assessed by norepinephrine (NE) spillover, was examined in conscious rabbits with adriamycin-induced cardiomyopathic heart failure (n = 5) and in control rabbits (n = 5). Each rabbit was studied after 4 and 6 wk of adriamycin (2 mg.kg-1.

Evaluation of UW solution in rat kidney preservation. II. The effect of pharmacological additives.

The present studies show clearly that both dexamethasone and insulin can be omitted without altering the efficacy of UW. Adenosine and glutathione are both helpful additives, as is allopurinol. These findings suggest an important role of reperfusion injury after preservation, and confirm the benefits of adding pharmacological agents likely to reduce this injury.

Tissue-specific regulation of the expression of rat kallikrein gene family members by thyroid hormone.

We have altered the thyroid hormonal status of both male and female rats and examined the expression of six functional members of the rat kallikrein gene family (PS, S1, S2, S3, K1 and P1) in the submandibular gland (SMG), kidney, prostate, testis and anterior pituitary gland (AP) of these animals. On Northern-blot analysis with gene-specific oligonucleotide probes, the steady-state mRNA levels of S1, S2, S3, K1 and P1 were all dramatically altered in the SMG of male and female rats treated with propylthiouracil (PTU; 100 mg/litre of drinking water) or thyroxine (T4; 10 micrograms/100 mg body wt.) for 3 weeks.

Paget's disease of the thoracic spine. A case report.

A case of cord compression, secondary to Paget's disease, and responding to medical therapy is presented. The role of current imaging techniques in this condition is discussed.

Recognition of insulin-like-growth-factor-binding proteins in serum and amniotic fluid by an antiserum against a low-molecular-mass insulin-like-growth-factor-inhibitor/binding protein.

An antiserum (R8) raised against a purified specific low-Mr (16,000-18,000) insulin-like-growth-factor (IGF)-inhibitor/binding protein, which is immunologically related to the native growth hormone (GH)-dependent Mr-150,000 IGF-binding protein in serum, has been used to probe a possible additional relationship to the predominant non-GH-dependent IGF-binding protein (Mr approximately 30,000) of human amniotic fluid. Amniotic-fluid fractions and an IGF-inhibitory fraction of serum were analysed by covalent cross-linking, ligand-blotting and immunoblotting techniques. Western blotting of the serum fraction using the R8 antiserum gave five immunoreactive (ir) bands, of which at least three (Mr 38,000, 34,000 and 23,000) possessed IGF-binding activity, as indicated by ligand (125I-IGF-I) blotting.

Evaluation of UW solution in a rat kidney preservation model. I. Effect of hydroxyethyl starch and electrolyte composition.

Preservation of rat kidneys by simple ice-storage has been demonstrated after 48 hr using the University of Wisconsin (UW) solution; hypothermic preservation of the rat kidney was dramatically improved. A modified UW solution without hydroxyethyl starch (HES) also gave uniform survival after 48 hr of storage, and even better function and morphology. Substitution of HES from another source also improved renal function when compared with UW (Dupont) and it is suggested that prolonged storage of UW solution prior to use may reduce its effectiveness.

Liver preservation with UW solution. I. Evidence that hydroxyethyl starch is not essential.

Preservation of rat livers by simple ice-storage has been demonstrated after 24 hr using the University of Wisconsin (UW) solution. Equally good preservation could be obtained by substituting hydroxyethyl starch (HES) from another source or by omission of HES from the UW formulation. Survival, early and late function, and morphology at the end of a 3-month follow-up period were essentially similar for all three test groups.

Medical problems in joint replacement patients: a retrospective study of 243 total hip arthroplasties.

Two hundred and forty-three total hip arthroplasties were performed in 217 patients over a five-year period in one institution. Seventy-one per cent had one or more significant preoperative medical problems, 22% being referred for preoperative management to a specialist physician. Thirty per cent of patients experienced re-activity of medical problems after operation; in 41% of patients a physician review was sought while in a further 40% the problems were apparently unnoticed or not acted upon.

11 beta-hydroxysteroid dehydrogenase activity in the mammary gland.

Levels of 11 beta-hydroxysteroid dehydrogenase activity in mammary gland homogenates from pregnant and lactating Sprague-Dawley rats were determined by incubation with [3H]corticosterone under standard conditions, followed by thin-layer chromatography of incubated media. Enzyme activity was high in virgin and pregnant rats, but fell soon after parturition, suggesting a possible role for this enzyme in the co-ordinate regulation of glucocorticoid effects on milk protein synthesis.

Shift in the baroreflex-renal noradrenaline spillover curve during the development of congestive heart failure in the rabbit.

1. Changes in renal sympathetic nerve activity (RSNA) were investigated during the development of congestive heart failure (CHF) in rabbits with doxorubicin-induced cardiomyopathy. 2.

Altered thyroidal status and the in vivo synthesis of atrial natriuretic peptide in the rat heart.

The effect of altered thyroidal status on levels of immunoreactive (ir)- atrial natriuretic peptide (ANP) in serum and the four cardiac chambers, and of tissue ANP mRNA, was determined in groups of rats given vehicle, thyroxine (T4), propylthiouracil (PTU) or T4 plus PTU for 3 weeks. Serum levels of ir-ANP were approximately 3-fold higher in T4-treated animals compared with control; levels in PTU or PTU/T4 groups were not different from control. Right ventricular ANP mRNA was below detection; in other chamber, levels rose with T4, alone or plus PTU, and fell after PTU compared with control.

Vasoconstriction in the renal vascular bed during exercise: studies in control and heart failure rabbits.

1. The effects of graded treadmill exercise on renal blood flow (RBF) were examined in seven rabbits, in which congestive heart failure (CHF) was produced by the administration of doxorubicin, 1 mg/kg, twice weekly for 8 weeks, and in seven controls. A third group of five rabbits underwent doxorubicin treatment with the addition of surgical section of the left renal sympathetic nerve.

Chloroquine Decreases Adrenocorticotrophin-Secretory Response to Corticotrophin-Releasing Factor but not to Vasopressin in Rat Pituitary Cells: Further Evidence for Differentially Responsive Subpopulations.

Abstract The relationships between adrenocorticotrophin (ACTH) content, basal ACTH secretion and the ACTH-secretory response to corticotrophin-releasing factor (CRF) or vasopressin in cultured rat anterior pituitary cells were examined in studies using chloroquine, an agent that diverts nascent ACTH from a storage pathway to direct release from cells. Chloroquine (200 mUM from t=minus 2 h) significantly elevated the basal ACTH secretory rate (by 0.7 +/- 0.

Clearance of vancomycin during continuous arteriovenous hemodiafiltration.

The clearance of vancomycin during therapy with continuous arteriovenous hemodiafiltration (CAVHD) has been measured in vivo. Vancomycin clearances (n = 16) were 0.636 +/- 0.