Human granulocytic ehrlichiosis complicating early pregnancy.

Background: The goal of this case is to review the zoonotic infection, human granulocytic ehrlichiosis, presenting with pyrexia. Case. A 22-year-old multigravid female presented to the emergency department with a painful skin rash, high fever, and severe myalgias.

Liver failure following partial hepatectomy.

While major liver resections have become increasingly safe due to better understanding of anatomy and refinement of operative techniques, liver failure following partial hepatectomy still occurs from time to time and remains incompletely understood. Observationally, certain high-risk circumstances exist, namely, massive resection with small liver remnants, preexisting liver disease, and advancing age, where liver failure is more likely to happen. Upon review of available clinical and experimental studies, an interplay of factors such as impaired regeneration, oxidative stress, preferential triggering of apoptotic pathways, decreased oxygen availability, heightened energy-dependent metabolic demands, and energy-consuming inflammatory stimuli work to produce failing hepatocellular functions.

Medical treatment of pediatric urolithiasis.

In recent years the incidence of pediatric stone disease has increased several fold, mostly due to hypercalciuria and hypocitraturia. The goal of medical treatment is to protect the patient from formation of new stones and expansion of existing ones. The non-pharmacological means to address stone disease include high fluid intake and, frequently, modification of nutritional habits.

Pharmacotherapy of insomnia.

Insomnia is the most common sleep disorder in the industrialized world. A variety of precipitating events have been identified, but when it becomes a persistent problem, maladaptive patterns become established, thereby, perpetuating the sleep disturbance. Individuals with insomnia have impaired next-day functioning, which impacts their quality of life and places them at increased risk of motor vehicle accidents.

A study comparing the plaque removal efficacy of an advanced rotation-oscillation power toothbrush to a new sonic toothbrush.

Objective: Recently, a new sonic power toothbrush has been marketed. The purpose of this study was to compare the plaque removal efficacy of a control rotation-oscillation power toothbrush (Oral-B Triumph) to this new sonic-powered toothbrush (Sonicare FlexCare) following a single brushing.

Methods: This study was a randomized, controlled, examiner-blind, two-treatment, four-period crossover design, which examined plaque removal with the two toothbrushes following replicate single uses in 48 subjects.

Preoperative acetaminophen vs ibuprofen for control of pain after orthodontic separator placement.

Introduction: Pain control during orthodontics is an important aspect of patient compliance. The aim of this prospective, randomized, double-blind clinical trial was to compare the pain control effectiveness of acetaminophen (650 mg) with ibuprofen (400 mg) taken 1 hour before separator placement in adolescents.

Methods: The patients recorded their discomfort on a 100-mm visual analog scale during several activities (teeth not touching, chewing, and fitting back teeth together) and by selecting words adapted from the McGill Pain Questionnaire at 5 time intervals: immediately before separator placement, immediately after separator placement, 2 to 3 hours later, at bedtime, and on awakening the next morning.

Income differentials required to make fellowship training in female pelvic medicine and reconstructive pelvic surgery financially neutral.

We used standard financial techniques and a return-on-educational-investment model to calculate the required annual income necessary to render additional fellowship training in female pelvic medicine and reconstructive pelvic surgery financially neutral. To explore a range of potential outcomes, we conducted a sensitivity analysis that used various discount rates and retirement ages. Compared to obstetrics/gynecology residents who go directly into private practice, residents who pursue fellowship training in female pelvic medicine and reconstructive pelvic surgery experience a financial loss of more than $400,000 to $600,000, assuming there is no income differential after fellowship.

Autoimmune lymphoproliferative syndrome in a patient with common variable immunodeficiency: dichotomy of apoptosis.

Background: Autoimmune lymphoproliferative syndrome (ALPS) is a disorder usually associated with hypergammaglobulinemia and defective apoptosis mostly due to Fas or Fas ligand mutation. Common variable immunodeficiency (CVID) is a disorder with hypogammaglobulinemia commonly associated with increased Fas expression and spontaneous apoptosis.

Objective: To describe a patient with a unique combination of hypogammaglobulinemia and ALPS with Fas deficiency but high spontaneous apoptosis.

Potential role for heparan sulfate proteoglycans in regulation of transforming growth factor-beta (TGF-beta) by modulating assembly of latent TGF-beta-binding protein-1.

Latent transforming growth factor-beta-binding proteins (LTBPs) are extracellular matrix (ECM) glycoproteins that play a major role in storage of latent TGF-beta in the ECM and regulate its availability. We have previously identified fibronectin as a key molecule for incorporation of LTBP1 and TGF-beta into the ECM of osteoblasts and fibroblasts. Here we provide evidence that heparan sulfate proteoglycans may mediate binding between LTBP1 and fibronectin.

Osteocyte messages from a bony tomb.

Until recently, osteocytes have escaped the limelight, embedded within their cave-like lacunae in the mineralized matrix of bone. In this issue of Cell Metabolism, Tatsumi et al. (2007) present evidence that this "third bone cell" can send either inhibitory signals to osteoclasts to maintain bone mass with normal loading or stimulatory signals to osteoclasts to initiate bone loss upon immobilization, thereby playing an indispensable role in skeletal homeostasis.

Effect of an angiotensin II receptor blocker and two angiotensin converting enzyme inhibitors on transforming growth factor-beta (TGF-beta) and alpha-actomyosin (alpha SMA), important mediators of radiation-induced pneumopathy and lung fibrosis.

Progressive, irreversible fibrosis is one of the most clinically significant consequences of ionizing radiation on normal tissue. When applied to lungs, it leads to a complication described as idiopathic pneumonia syndrome (IPS) and eventually to organ fibrosis. For its high mortality, the condition precludes treatment with high doses of radiation.

Use of the multipurpose drainage catheter for the provision of acute peritoneal dialysis in infants and children.

Background: Prior experience with the Cook (Cook Inc, Bloomington, IN) Teflon rigid catheter (CTC) showed it to be a suboptimal access for acute peritoneal dialysis (PD) treatment in infants and children because of the frequency of catheter-related complications associated with its use. The objective of this study is to report our experience with the bedside-placed flexible Cook Mac-Loc Multipurpose Drainage catheter (CMMDC) for acute PD in critically ill infants, comparing it with the historic Tenckhoff catheter (TC) and CTC use.

Study Design: Retrospective cohort study.

Outcome of infants born to women with chronic kidney disease.

Pregnancy in women with chronic kidney disease is not uncommon and is not without risk to the mother and child. This article reviews the literature on the outcome of infants from pregnancies in women with chronic kidney disease (CKD), including those receiving dialysis and those living with a functional kidney transplant. Pregnancy in women with CKD and end-stage renal disease (ESRD) is associated with a higher rate of premature birth and small-for-gestational-age (SGA) infants, with resultant increase in neonatal mortality.

Mental health promotion: is nursing dropping the ball?

As a discipline, nursing has espoused a philosophy of caring for the whole person, including not only the physical but also the psychosocial and spiritual realms. Health promotion and the desire to promote healthy communities are a focus of the discipline and are evidenced by the curricula in nursing programs as well as community activism by individuals and groups of nurses. Although health promotion should include measures to address not only physical but also mental health, there is a disparity in the nursing literature regarding mental health promotion.

A structural basis for complement inhibition by Staphylococcus aureus.

To provide insight into bacterial suppression of complement-mediated immunity, we present here structures of a bacterial complement inhibitory protein, both free and bound to its complement target. The 1.25-A structure of the complement component C3-inhibitory domain of Staphylococcus aureus extracellular fibrinogen-binding protein (Efb-C) demonstrated a helical motif involved in complement regulation, whereas the 2.

Measurement of urea nitrogen and creatinine concentrations in peritoneal dialysate and other body fluids using the Vitros analyzer.

Objectives: A majority of chemistry analyzers have separate modes for estimating urea nitrogen and creatinine in serum and urine because of significant differences in their concentration. As there is no defined mode for other biological fluids such as dialysis fluid, these can be run on either of the two modes. On Vitros (Clinical Ortho-Diagnostics, Rochester, NY) chemistry analyzer, we observed an overestimation in calculated creatinine clearance (CrCl) and Kt/V(urea) in some children that led us to investigate into methodology used for these assays.

Polymorphism R62W results in resistance of CD23 to enzymatic cleavage in cultured cells.

A nonsynonymous single nucleotide polymorphism (SNP) of the low-affinity IgE receptor (FcvarepsilonRII/CD23) gene resulting in an arginine to tryptophan exchange at amino-acid position 62 (R62W) has been associated with enhanced T-cell responses to antigen in allergic subjects. To explore the mechanism, a CD23(a) cDNA was cloned into the plasmid pCMVScript-CD23a-C with a C allele (R62). The pCMVScript-CD23a-T with T (W62) was produced using a site-directed mutagenesis approach.

Massive leiomyoma of the broad ligament.

Background: A primary broad ligament leiomyoma weighing greater than 50 kg presented unique perioperative complications.

Case: A postmenopausal nulligravida presented to the emergency department for a fractured patella with an incidental finding of a massive abdomen. The patient underwent laparotomy to remove a 51-kg broad ligament leiomyoma.

Holocene coccidioidomycosis: Valley Fever in early Holocene bison (Bison antiquus).

Early Holocene bison mandibles (Bison antiquus) from Nebraska, ca. 8500 y ago, were examined with a variety of modern histotechnological procedures and staining techniques. A pathological, anatomical diagnosis of moderately severe, locally extensive, mandibular osteomyelitis with intralesional spherules morphologically consistent with fungal pathogens in the genus Coccidioides was made.

Clear cell sarcoma of tendons and aponeuroses: a review.

Clear cell sarcoma of tendons and aponeuroses, also referred to as malignant melanoma of soft parts, is a rare malignancy derived from neural crest cells. It usually presents in the distal lower extremities of young adults, frequently attached to tendons or aponeuroses. It behaves like a high-grade soft tissue sarcoma and is associated with poor overall survival.

Vancomycin disposition following intraperitoneal administration in children receiving peritoneal dialysis.

Background: Little information is available on the disposition of vancomycin during chronic peritoneal dialysis (PD) in children. The primary objective of this study was to investigate the disposition of vancomycin following intraperitoneal (IP) administration in children receiving short-dwell [e.g.