Fludrocortisone Therapy in Renal Transplant Recipients with Persistent Hyperkalemia

Hyperkalemia after kidney transplantation is a common electrolyte disturbance and the risk factors are multifactorial. Pharmacotherapeutic agents for chronic management of hyperkalemia in kidney transplant patients may be relatively contraindicated or provide suboptimal efficacy. Fludrocortisone, an endogenous mineralocorticoid mimics the actions of aldosterone, hence hyperkalemia reversal. We describe three- case series of persistent hyperkalemia with demonstrated benefit from fludrocortisone therapy. Our three renal transplant recipients with multiple emergency room visits for elevated serum potassium levels despite treatment with diuretics, sodium bicarbonate, and sodium polystyrene sulfonate responded well to fludrocortisones therapy. Upon fludrocortisone initiation and maintenance therapy, all three patients experienced a decline in serum potassium levels to normal reference range

Advances in imaging chest tuberculosis: blurring of differences between children and adults

This article reviews the ongoing role of imaging in the diagnosis of tuberculosis (TB) and its complications. A modern imaging classification of TB, taking into account both adults and children and the blurring of differences in the presentation patterns, must be absorbed into daily practice. Clinicians must not only be familiar with imaging features of TB but also become expert at detecting these when radiologists are unavailable. Communication between radiologists and clinicians with regard to local constraints, patterns of disease, human immunodeficiency virus (HIV) coinfection rates, and imaging parameters relevant for management (especially in drug resistance programs) is paramount for making an impact with imaging, and preserving clinician confidence. Recognition of special imaging, anatomic and vulnerability differences between children and adults is more important than trying to define patterns of disease exclusive to children

A culminating experience as a graduate student in music

Written in 1809 and dedicated to his friend and student, Archduke Rudolph von Osterreich, Ludwig van Beethoven's Piano Sonata in E flat major Op. 81a celebrates the friendship that these two men had nurtured. Though the composer had written inscriptions for each movement as "les adieux, l'absence et le retour", the piece is not a dedication of love as it may have been romanticized. The slow introduction of the first movement is made up of a three note motive whose intervals gradually increase from a major third, a perfect fifth, to a minor sixth showing a distinct feeling of gradually growing distance. The same theme is used in the development section as well as the coda where it is used in counterpoint. The second movement has a melancholy character rich in emotion and harmonies. As the movement comes to an end, there is a sudden eruption of sound and the immediate entrance of the third movement and the friend's return is greeted by a great exclamation of joy. (See more in text.)California State University, Northridge. Department of Music.Includes recorded audio files in WAV and MP3 format, 63:55 in length

Layers

INTRODUCTION Within the essence of the impetus of my work is the disavowal of the concept of art for art's sake, and the repudiation of the activity of art when it is practiced as escapism. My commitment to art is a discipline involving my total being, and my tools, in an intense relationship--an embrace with life. I work to express a timely awareness of the human condition. My images are derived from an inner vision focused on the sexual dimension of life which I believe to be the foundation of existence, an immensely powerful core incorporating psychic, physical, as well as social and political states. My motivation to create relevant images brings me in contact with certain realities which I acknowledge as secondary, yet important aspects to deal with in my growth as an artist. These realities are (1) the necessity of a pro-feminist outlook, (2) the necessity to rise above the predominantly technical emphasis of printmaking and make use of the media as a means for transmitting ideas. (See more in text.)Includes bibliographical references (page 19)California State University, Northridge. Department of Art

An introductory handbook on the construction and use of metaphor in therapy

Change occurs on the psychological level when a person's world model becomes enhanced in such a way as to allow for new solutions to old problems. Therapeutic metaphors enable this to happen by initiating transderivational searches which assist in the acquisition and enrichment of the personal resources which are necessary for growth. The power and beauty of using metaphor in therapy was made evident through the work of Milton Erickson. A therapeutic metaphor must accurately depict the problematic situation of the client so that his unconscious mind will accept the metaphor as being isomorphic. It must also contain a strategy and solution which the client can utilize in order to generate new choices. Effectiveness of the therapeutic metaphor is enhanced by incorporating acknowledgement of representational system relevance, and by skillful use of syntax.Includes bibliographical references (pages 100-101)California State University, Northridge. Department of Education

Low-Dose DDAVP in Nocturnal Enuresis

A five-year experience with the vasopressin analogue desmopressin acetate (DDAVP) for nocturnal enuresis is described in 59 children. The initial starting dose of 5 μg at bedtime is lower than that reported in other series. Eighty-one percent of patients required 10 μg or less to achieve improvement or resolution of bedwetting.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67971/2/10.1177_000992289203100507.pd

Polycystic kidney disease in patients on the renal transplant waiting list: trends in hematocrit and survival

BACKGROUND: The patient characteristics and mortality associated with autosomal dominant polycystic kidney disease (PKD) have not been characterized for a national sample of end stage renal disease (ESRD) patients on the renal transplant waiting list. METHODS: 40,493 patients in the United States Renal Data System who were initiated on ESRD therapy between 1 April 1995 and 29 June 1999 and later enrolled on the renal transplant waiting list were analyzed in an historical cohort study of the relationship between hematocrit at the time of presentation to ESRD and survival (using Cox Regression) in patients with PKD as a cause of ESRD. RESULTS: Hematocrit levels at presentation to ESRD increased significantly over more recent years of the study. Hematocrit rose in parallel in patients with and without PKD, but patients with PKD had consistently higher hemoglobin. PKD was independently associated with higher hematocrit in multiple linear regression analysis (p < 0.0001). In logistic regression, higher hematocrit was independently associated with PKD. In Cox Regression analysis, PKD was associated with statistically significant improved survival both in comparison with diabetic (hazard ratio, 0.64, 95% CI 0.53–0.77, p < 0.001) and non-diabetic (HR 0.68, 95% CI 0.56–0.82, p = 0.001) ESRD patients, adjusted for all other factors. CONCLUSIONS: Hematocrit at presentation to ESRD was significantly higher in patients with PKD compared with patients with other causes of ESRD. The survival advantage of PKD in ESRD persisted even adjusted for differences in hematocrit and in comparison with patients on the renal transplant waiting list

Clinical characteristics and outcome of dogs with presumed primary renal lymphoma

Objectives: To characterise the presentation, clinicopathologic data and outcome of 29 dogs with presumed primary renal lymphoma. Materials and methods: Retrospective analysis of medical records of dogs with suspected primary renal lymphoma from 11 institutions. Results: All dogs were substage b, and lethargy and gastrointestinal signs were common presenting complaints, as were azotaemia (n=25; 86%) and erythrocytosis (n=15; 51%) on biochemical testing. Ultrasonography typically revealed bilateral renal lesions (n=23; 79%), renomegaly (n=22; 76%) and abdominal lymphadenopathy (n=14; 48%). Chemotherapy was the only treatment in 23 dogs, of which 11 responded, all considered partial responses. For all dogs the median progression-free survival and median overall survival times were 10 days (range: 1 to 126) and 12 days (range: 1 to 212), respectively, and for dogs that responded to chemotherapy 41 days (range: 10 to 126) and 47 days (range: 10 to 212), respectively. Clinical significance: Primary renal lymphoma in dogs appears to be associated with a poor prognosis and short-lived response to chemotherapy

Throat related symptoms and voice: development of an instrument for self assessment of throat-problems

<p>Abstract</p> <p>Background</p> <p>Symptoms from throat (sensation of globus; frequent throat clearing; irritated throat) are common in patients referred to voice clinics and to ENT specialists. The relation to symptoms of voice discomfort is unclear and in some cases patients do not have voice problems at all. Instruments for patients' self-reporting of symptoms, and assessment of handicap, such as the Voice Handicap Index (VHI), are in common use in voice clinics. Symptoms from throat are however only marginally covered. Purpose: To develop and evaluate an instrument that could make the patients' estimation of symptoms from the throat possible. Further to facilitate the consideration of the relation between throat- and voice problems with the Throat subscale together with a Swedish translation of the Voice Handicap Index. Finally to try the VHI with the Throat subscale: the VHI-T, for test-retest reliability and validity.</p> <p>Methods</p> <p>A subscale with 10 throat related items was developed for appliance with the VHI. The VHI was translated to Swedish and retranslated to English. The questionnaire was tried in two phases on a total of 23+144 patients and 12+58 voice healthy controls. The reliability was calculated with Cronbach's alpha, ICC and Pearson's correlation coefficient. The validity was estimated by independent T-test.</p> <p>Results</p> <p>The difference in VHI-T scores between the patients and the voice-healthy controls was significant (<it>p </it>= < 0,01) and there was a good correlation of the test- retest occasions. The reliability testing of the entire questionnaire showed an alpha value of <it>r </it>= 0,90 and that for the Throat subscale separately a value of <it>r </it>= 0,87 which shows a high degree of reliability.</p> <p>Conclusions</p> <p>For the estimation of self-perceived throat and voice problems the scale on throat related problems together with the present Swedish translation of the Voice Handicap Index, (VHI) the VHI-Throat, proves to be a valid and reliable instrument. The throat subscale seems to help revealing a category of symptoms that are common in our patients. These are symptoms that have not earlier been possible to cover with the questionnaires designed for use in the voice clinic.</p