Increased chest CT derived bone and muscle measures capture markers of improved morbidity and mortality in COPD.

Background: Chronic obstructive pulmonary disease (COPD) is a disease of accelerated aging and is associated with comorbid conditions including osteoporosis and sarcopenia. These extrapulmonary conditions are highly prevalent yet frequently underdiagnosed and overlooked by pulmonologists in COPD treatment and management. There is evidence supporting a role for bone-muscle crosstalk which may compound osteoporosis and sarcopenia risk in COPD.

Clobetasol Compared With Fractionated Carbon Dioxide Laser for Lichen Sclerosus: A Randomized Controlled Trial.

Objective: To compare 6-month safety and efficacy outcomes of fractionated CO2 laser (laser) with topical clobetasol propionate (steroid) for treatment of symptomatic vulvar lichen sclerosus.

Methods: We conducted a single-center randomized controlled trial that compared fractionated CO2 laser with steroid treatment for patients with biopsy-proven lichen sclerosus. Randomization was stratified by prior clobetasol propionate use.

Mammary analog secretory carcinoma of salivary gland with high-grade histology arising in hard palate, report of a case and review of literature.

Mammary gland analog secretary carcinoma (MASC) of salivary gland is typically a tumor of low histologic grade and behaves as a low-grade malignancy with relatively benign course. This tumor shares histologic features, immunohistochemical profile, and a highly specific genetic translocation, ETV6-NTRK3, with secretory carcinoma of breast. Histologically, it is often mistaken as acinic cell carcinoma, adenocarcinoma not otherwise specified, and other primary salivary gland tumors.

Reconstruction of the interosseous ligament of the forearm reduces load on the radial head in cadavers.

Excision of the radial head after fracture may be complicated by longitudinal radio-ulnar instability (Essex-Lopresti lesion) if the forearm interosseous ligament has also been torn. In such cases proximal migration of the radius occurs, and ulnar impaction at the wrist and radiocapitellar contact at the elbow may impair function. Although metal radial head arthroplasties are now used for irreparable radial head fractures, the long-term clinical outcome may still be unsatisfactory because of excessive radiocapitellar load causing pain.

Morphological and functional changes in cardiac myocytes isolated from mice overexpressing TNF-alpha.

Transgenic (TG) TNF1.6 mice, which cardiac specifically overexpress tumor necrosis factor-alpha (TNF-alpha), exhibit heart failure (HF) and increased mortality, which is markedly higher in young (<20 wk) males (TG-M) than females (TG-F). HF in this model may be partly caused by remodeling of the extracellular matrix and/or structure/function alterations at the single myocyte level.

Exaggerated cardiovascular effects of cocaine in conscious dogs with pacing-induced dilated cardiomyopathy.

Background: The aim of this study was to explore the characteristics and mechanisms of the cardiovascular effects of cocaine in dilated cardiomyopathy.

Methods And Results: We studied the cardiovascular responses to acute intravenous cocaine (1 mg/kg) in 8 conscious, chronically instrumented dogs before and after the development of dilated cardiomyopathy induced by rapid ventricular pacing. To help elucidate the role of altered baroreflex function in mediating the cardiovascular effects of cocaine, we also studied responses in 3 conscious, chronically instrumented dogs that had undergone surgical sinoaortic baroreceptor denervation.

Reevaluating the role of phosphodiesterase inhibitors in the treatment of cardiovascular disease.

First developed for clinical use in the late 1980s, the phosphodiesterase inhibitors were found to increase the levels of the ubiquitous second messenger cyclic adenosine monophosphate and could effect changes in vascular tone, cardiac function, and other cellular events. After several early studies using high doses of phosphodiesterase inhibitors in patients with severe heart failure suggested adverse consequences, they fell out of favor. However, recent investigations of phosphodiesterase inhibitors in patients with intermittent claudication have demonstrated profound benefits.

The evolving role of topiramate among other mood stabilizers in the management of bipolar disorder.

Objectives: Topiramate, a structurally novel anticonvulsant, is being evaluated for other neurological conditions such as migraine, neuropathic pain, and essential tremor, and also for psychiatric conditions such as bipolar disorder, bulimia, post-traumatic stress disorder, and schizoaffective disorder, in addition to obesity. This article will focus on the use of topiramate for bipolar disorder.

Methods: The pharmacological profile of topiramate is compared to other established and putative mood stabilizers, and a rationale for its use in bipolar disorder is presented.

Brain death and organ donation.

Critical care nurses are essential team members during the process of determining brain death and preparing for organ donation. Using their knowledge of the criteria for brain death, they care for the dying patient, support the grieving family, and participate in the consent process for organ donation. Nurses make a critical difference in saving the lives of others through the gift of life.

Traumatic brain injury research: a review of clinical studies.

There is a growing volume of research on trauma brain injury (TBI) as evidenced by a recent Medline search that reported over 6000 articles published on TBI in the past 5 years.

Effect of positioning on oxygenation in single-lung transplant recipients.

Background: Many benefits and adverse effects of positioning are related to changes in ventilation and perfusion. A number of unique factors related to the allograft make the effects of positioning difficult to determine in single-lung transplant recipients.

Objectives: To determine the effect of 3 body positions (supine, lateral with allograft lung down, and lateral with native lung down) on oxygenation and blood flow in single-lung transplant recipients in the 24 hours immediately after surgery.

Changes in autonomic activity and ventricular repolarization.

An increase in sympathetic activity, manifested by shortening of RR intervals (RRi) and changes in RRi variability, precedes and possibly triggers ventricular tachyarrhythmias (VTAs) by altering repolarization. We examined the effects of autonomic activity on the projection of repolarization as detected by body surface potential maps (BSPMs). We recorded 32 lead/192-point BSPMs during passive head-up tilt, tilt + infusion of isoproterenol, rapid atrial pacing, and atrial pacing + infusion of isoproterenol.

The older patient with a spinal cord injury.

The most common cause of spinal cord injury (SCI) in older persons is falls, followed by motor vehicle crashes and pedestrian/motor vehicle crashes. Upper cervical injuries, particularly central cord syndrome, are prominent in the geriatric patient population. In addition, the mortality is higher, the complications are life threatening, the hospital stay is longer, and the cost of care is significantly increased for the older trauma victim.

Mechanical circulatory support with the Novacor LVAS: world-wide clinical results.

The Novacor left-ventricular assist system (LVAS) is an implantable, electrically powered device that is presently approved both in Europe and in the United States for temporary use as a bridge to cardiac transplantation in patients with advanced heart failure. The device has undergone significant evolution since its first implantation in 1984. This device provides a safe, and effective "bridge" to transplantation in select candidates.

Fetal radius length: a critical evaluation of race as a factor in gestational age assessment.

Growth of the fetal radius was examined ultrasonographically in a prospective cross-sectional study of 290 white and 63 black patients between 12 and 43 weeks' gestation. The mean of radius length and 95% predictive intervals were calculated for each week. The most efficient description of the data was given by a simple log-linear model.

Thigh circumference in the detection of intrauterine growth retardation.

Intrauterine growth retardation (IUGR) is associated with an increase in perinatal mortality as well as long-term neurobehavioral morbidity. Despite the increasing sophistication of antenatal fetal assessment, the diagnosis of growth retardation remains difficult. Since the fetal effects of growth inhibition are variable, no one ultrasonic parameter can diagnose with certainty the growth-retarded fetus.

A combined historic and sonographic score for the detection of intrauterine growth retardation.

Sonographic analysis of fetal biometry has been useful in the antepartum detection of intrauterine growth retardation (IUGR). Little attention, however, has been focused upon elements of the maternal and fetal history that may significantly affect the likelihood of IUGR. To define more precisely both the clinical and sonographic parameters associated with IUGR, we studied the following variables: routine fetal biometry (biparietal diameter, head circumference, abdominal circumference, and femur length), fetal weight percentile, amniotic fluid volume, and an antenatal scoring system for IUGR.

Resolving polyhydramnios. A sign of improved fetal status.

Four cases of transient polyhydramnios are reviewed. It is proposed that by taking note of changes in amniotic fluid volume, one can more accurately assess a fetal-maternal unit that is affected by a number of specific disease processes.

Sonographic evaluation of the cervix during ovulation induction.

With the induction of ovulation, clomiphene citrate and human menopausal gonadotropin have the potential to stimulate the endocervical glands. We have found that the degree of mucus production can occasionally be quite large and hence is detectable by sonographic evaluation as an anechoic cervical mass. The incidence of this specific ultrasonic finding was found to be approximately 5%.