Starting ketamine for neuroprotection earlier than its current use as an anesthetic/antiepileptic drug late in refractory status epilepticus.

Ketamine is currently being used as an anesthetic/antiepileptic drug in refractory status epilepticus. To validate its use, 2 clinical trials are recruiting patients. However, preclinical studies of its use in chemically induced status epilepticus in rodents have shown that it is remarkably neuroprotective, through N-methyl-d-aspartate-receptor blockade, even when given after the onset of status epilepticus.

Zirconium: biomedical and nephrological applications.

Recent years have witnessed a rapid increase in the use of zirconium (Zr)-containing compounds in artificial internal organs. Examples include dental implants and other restorative practices, total knee and hip replacement, and middle-ear ossicular chain reconstruction. In nephrological practice, Zr-containing sorbents have been used in hemofiltration, hemodialysis, peritoneal dialysis, and in the design and construction of wearable artificial kidneys.

Idiopathic juxtafoveal retinal telangiectasia.

Background: Idiopathic juxtafoveal retinal telangiectasia (IJRT) is a rare retinal condition that can be detected even in asymptomatic patients. The most common appearance, type 2A, typically presents as juxtafoveolar telangiectasias with minimal exudation, superficial retinal crystalline deposits, and right-angle venules. Though initially asymptomatic, late complications such as foveolar atrophy and subretinal neovascularization can develop and should be recognized and treated accordingly.

A peritoneal-based automated wearable artificial kidney.

Work on wearable kidneys has evolved around the technology of hemodialysis or hemofiltration, which call for continuous anticoagulation of the extracoporeal circulation and are encumbered with potential immunologic and non-immunologic complications of continuous blood-artificial membrane interactions. A peritoneal-based automated wearable artificial kidney (AWAK) requires no extracorporeal circulation and is therefore "bloodless." Because AWAK is designed to continuously regenerate and reuse the spent dialysate in perpetuity, it is also "waterless.

Involvement of trainees in routine unsedated colonoscopy: review of a pilot experience.

Background: Unsedated colonoscopy is not required by the Accreditation Council of Graduate Medical Education in the curriculum of GI trainees.

Objective: We describe our pilot experience with trainee participation in unsedated colonoscopy.

Design: A retrospective review of a performance improvement program to provide access to colonoscopy.

Racial and ethnic disparities in the use of mental health services.

The authors used data from the 1998-1999 Community Tracking Study (CTS) household survey to examine variations in predictors of use of mental health services among different racial and ethnic groups (white, African American, Hispanic, and other). African Americans and Hispanics were less likely to have visited a mental health professional (MHP) in the prior year than were whites. Independent of health insurance and health status, low- to middle-income African Americans may be at particular risk for inadequate use of an MHP compared to higher-income African Americans.

Pilot studies to demonstrate that intestinal mucosal afferent nerves are functionally linked to visceral adipose tissue.

Dietary capsaicin reduces rodent visceral fat weight. We tested the hypothesis that intact intestinal mucosal afferent nerve function is necessary for fat deposition in visceral adipose tissue sites. Rats were treated daily for 2 weeks with intragastric (chronic treatment) vehicle or capsaicin.

Etiologic factors of chronic constipation: review of the scientific evidence.

Geriatric patient educational material and a general practice review suggest insufficient dietary fiber intake, inadequate fluid intake, decrease physical activity, side effects of drugs, hypothyroidism, sex hormones and colorectal cancer obstruction may play a role in the pathogenesis of constipation. A search of recent literature, however, reveals that there is a paucity of evidence-based publications that address the etiologic factors of chronic constipation. Much of current writings on the subject may be based primarily on myths handed down from one generation to the next.

Primary acquired melanosis of the conjunctiva.

Background: Primary acquired melanosis (PAM) presents as a unilateral patchy area of conjunctival pigmentation mostly found in middle-aged or elderly white patients. Because PAM has the potential of becoming malignant, it is important to recognize PAM and to rule out other causes of pigmented lesions. The presence or absence of atypia is helpful in determining the potential for malignancy, because PAM without atypia is usually benign, whereas PAM with atypia may convert into a conjunctival melanoma.

Treatment of cytomegalovirus retinitis with oral valganciclovir in an acquired immunodeficiency syndrome patient unresponsive to combination antiretroviral therapy.

Background: Cytomegalovirus (CMV) retinitis was a much-feared visual complication of late-stage acquired immunodeficiency syndrome (AIDS) in the past. Its incidence has waned significantly owing to the benefits of potent antiretroviral combination therapy, which for many individuals has provided some degree of immune reconstitution and avoidance of opportunistic infections, particularly this blinding disease.

Case Report: A 45-year-old white man with long-standing, multidrug-resistant human immunodeficiency virus (HIV) infection and severe immunodeficiency despite multiple antiretroviral drug regimens, presented to the eye clinic reporting decreased vision and spider web patterns in his left eye for the past week.

Adult-onset foveomacular vitelliform dystrophy.

Background: Adult-onset foveomacular vitelliform dystrophy (AOFVD) is a condition that presents classically as bilateral, symmetrical, grayish-yellow, round or oval-shaped lesions within the macular area. These lesions are mildly elevated and are typically one third to one half disc diameter in size. The onset of the disease is usually between 30 and 50 years of age with variable genetic inheritance, although some have suggested an autosomal dominance inheritance pattern.

Advance care planning documents in nursing facilities: results from a nationally representative survey.

This study assessed clinical, demographic, facility, and regional factors associated with documented do-not-resuscitate (DNR) orders, feeding/medication/other treatment (FMT) restrictions, and living wills among nursing facility residents. Using the Nursing Home Component of the 1996 Medical Expenditure Panel Survey, a nationally representative sample of 815 facilities and 5899 residents, three separate multivariate logistic regression models were developed. DNR orders were more prevalent among residents aged 75+ and those with severe cognitive impairment, dementia, emphysema, and cancer, but less common among African Americans and Latinos than whites.

Tuberculum sellae meningioma associated with lymphomatoid papulosis.

Background: Meningiomas involving the tuberculum sellae and planum sphenoidale typically cause visual loss by affecting the optic nerve and anterior chiasm. We present a case of a tuberculum sellae meningioma concurrent with lymphomatoid papulosis, a T-cell lymphomatoid skin disorder.

Case Report: A 50-year-old black woman came to the eye clinic with a symptom of decreased vision in the right eye for one week, especially when reading.

Acid-induced mesenteric hyperemia in rats: role of CGRP, substance P, prostaglandin, adenosine, and histamine.

Intraduodenal acidification produces a mesenteric hyperemia that is mediated in part by mucosal capsaicin-sensitive afferent nerves and the bradykinin B2 receptor in anesthetized rats. We hypothesized that novel mechanisms mediated by substance P, adenosine, and histamine1 receptors are involved. Confirmation of a role for calcitonin gene-related peptide (CGRP) but not endogenous prostaglandin was also sought.

The organization and delivery of women's health care in Department of Veterans Affairs Medical Center.

Congressional eligibility reforms have profoundly changed the array of services to be made available to women veterans in Department of Veterans Affairs (VA) health care facilities. These include access not only to primary and specialty care services already afforded VA users, but also to a full spectrum of gender-specific services, including prenatal, obstetric, and infertility services never before provided in VA settings. The implications of this legislative mandate for delivering care to women veterans are poorly understood, as little or no information has been available about how care for women veterans is organized.

Ruthenium red-sensitive cation channels, but not calcitonin gene-related peptide or substance P-mediated mechanisms, protect duodenal villi against acid-induced damage.

Intestinal mucosal capsaicin-sensitive afferent nerves mediate, in part, the protective mesenteric hyperemia after intraduodenal acidification. Mechanisms associated the sensory neuropeptides, e.g.

Nonconvulsive status epilepticus with frontal features: quantitating severity of subclinical epileptiform discharges provides a marker for treatment efficacy, recurrence and outcome.

Nonconvulsive status epilepticus (NCSE) is difficult to diagnose but is an important cause of cognitive impairment. Electroencephalogram (EEG) monitoring is required for diagnosis and treatment. Little is known regarding the stability of subclinical epileptiform discharges (SEDs) preceding NCSE nor what strategies may optimize patient outcomes.

Effects of AMPA-receptor and voltage-sensitive sodium channel blockade on high potassium-induced glutamate release and neuronal death in vivo.

High extracellular potassium induces spreading depression-like depolarizations and elevations of extracellular glutamate. Both occur in the penumbra of a focal ischemic infarct, and may be responsible for the spread of cell death from the infarct core to the penumbra. We have modeled this situation with microdialysis of an isotonic high-potassium solution into the normal rat amygdala for 70 min.

Ocular and systemic findings and their correlation with hemodynamically significant carotid artery stenosis: a retrospective study.

Background: Optometrists often encounter patients with ocular signs and/or symptoms suggestive of carotid artery disease, but criteria for eye care practitioners concerning when to order carotid studies are not well established. A retrospective study in an optometry clinic was performed to determine if certain ocular findings and associated systemic risk factors were associated with hemodynamically significant carotid artery stenosis (HSCAS).

Methods: A retrospective analysis was performed on all patients examined in the optometry clinic at the Sepulveda Ambulatory Care Center from January 1, 1998 through December 31, 1999 to identify all patients who had carotid studies ordered.

Juxtapapillary capillary hemangioblastoma.

Background: Juxtapapillary capillary hemangioblastomas are vascular lesions that occur on the optic nerve head or immediately adjacent to the optic disc. Although juxtapapillary capillary hemangioblastomas may appear as an isolated clinical finding, they are more likely to be a precursor to the diagnosis of von Hippel-Lindau (VHL) disease. When associated with VHL, the ocular complications from hemangioblastoma are generally greater, and subsequently the prognosis is poorer than for isolated entities.

Role of bradykinin in acid-induced mesenteric hyperemia and duodenal villous damage.

Intestinal mucosal capsaicin-sensitive afferent nerves mediate, in part, the mesenteric hyperemia after intraduodenal acidification. The hyperemia plays a role in protecting the duodenal mucosa against acid damage. We tested the hypothesis that bradykinin contributes to this protective hyperemia.

Non-Hodgkin's orbital lymphoma.

Background: The non-Hodgkin's lymphomas (NHL) are a group of neoplasms characterized by proliferation of malignant lymphocytes. Patients with NHL have a wide variety of presenting signs and symptoms, depending largely on the site of involvement and aggressiveness of the disease. Many organs in the body may be affected, including the eye and orbit.

Stimulation of intestinal mucosal afferent nerves increases superior mesenteric artery and decreases mesenteric adipose tissue blood flow.

We tested the hypothesis that stimulation of intestinal mucosal afferent nerves produces an increase in superior mesenteric artery (SMA) but a decrease in mesenteric adipose tissue (MAT) blood flow. In anesthetized rats, blood flow in the SMA (pulsed Doppler flowmetry) and MAT (hydrogen gas clearance) was measured simultaneously before and after administration of 0.9% saline, 640 microM capsaicin, or 5% dextrose into the intestinal lumen.

Bilateral occipital lobe stroke with inferior altitudinal defects.

Background: Cerebrovascular disease is the most common cause of neurological disability in Western countries. Patients who survive cerebrovascular accidents exclusive to the occipital lobe often have no significant neurological deficits other than visual-field loss. Visual-field defects from occipital lobe stroke typically include congruous homonymous hemianopsias or quadranopsias, with or without macular sparing.