Education of the child with juvenile-onset diabetes mellitus: an example of cost containment.
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Biomedical subjects
Publications and source records attributed to R J Cunningham.
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A dialysis equilibrium method for plasma or tissue preparation for radioimmunoassay of prostaglandins is presented and compared to the silica gel column technique. The plasma or tissue is extracted, dried, redissolved in buffer and dialyzed for further purification before assay. Results comparing both methods shows that dialysis equilibrium greatly simplifies the silica gel column technique yet preserves specificity, sensitivity and reproducibility. In addition a rapid micromethod for the development of a specific antibody to prostaglandin A is detailed.
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In 1971 Simmons et al. presented evidence that children receiving regular dialysis therapy required approximately seventy percent of recommended caloric intake to achieve normal growth. Since that time, pediatric nephrologists and dietitians have strived to meet that requirement. In an effort to attain adequate caloric intake, cyproheptadine, a known appetite stimulant, was prescribed to a child on chronic hemodialysis. The following reports the unexpected complication of toxic psychosis that resulted.
Studies to determine the effect of kidney parenchymal infection upon urinary lactic dehydrogenase (ULDH) isoenzyme composition were performed in 12 female Sprague-Dawley rats on Day 0 and on Days 2, 5, and 10, after experimental inducement of Escherichia coli pyelonephritis. An additional group of 12 animals was subjected to similar experimental manipulations and served as sham controls. Repeated 12-h urine collections revealed lower urine osmolalities and significantly higher levels of ULDH 5 excretion in the experimental than in the sham operated animals (P less than 0-05). These differences persisted for the length of the experiment (10 days). Leucocyte excretion rates were also higher in the experimental than in the sham group, and a high correlation with ULDH 5 activity was demonstrated (r = 0-815). No other evidence that the two variables may be causally related was found.
The renal medulla is not often considered an endocrine organ, but recent evidence suggests that this part of the kidney may have important antihypertensive, endocrine functions. The antihypertensive factor(s) of the medulla have been localized to the interstitial cells and characterized as neutral and acidic lipids. The acidic lipids, or protstaglandins, have been the more extensively investigated. Animal and human studies indicate that prostaglandins may influence systemic arterial pressure directly or indirectly by promoting excretion of salt and water. Recent evidence suggests that prostaglandins may be mediators of the renin-angiotensin-aldosterone system, thus influencing blood pressure via this system that plays such a key role in blood pressure control.
Glomerular filtration rate (GFR) is often used to evaluate and manage patients with renal disease. Few studies in children have compared accurate estimations of GFR (clearance of inulin and/or iothalamate) with the clearance of creatinine which, because of simplicity, has been used as an approximation of GFR. At reduced levels of GFR, studies in adults suggest that the mean of the creatinine and urea clearances closely approximate the GFR. The present investigation shows that the clearance of creatinine approximates the GFR at normal levels; however, at reduced levels the creatinine clearance and the mean of the creatinine and urea clearances both overestimate the GFR as measured by iothalamate. The clearance of creatinine remains a useful clinical tool if its limitations at low levels of GFR are realized.
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Three children presented with proteinuria, microscopic hematuria, episodic gross hematuria and normal renal function. Renal histology consisted predominantly of mesangial IgA deposition. The above clinical and biopsy findings are consistent with a diagnosis of IgA nephropathy. To date, these 3 children have maintained normal renal function. The authors hypothesize that this may be due to the absence of simultaneous complement deposition within the glomerulus.
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The clinical illnesses observed in three adolescents with Nocardia asteroides infection are described. The organism has been classified as a bacterium and placed in the Actinomycetaceae family. Sulfonamides remain the first choice for chemotherapy but alternative drugs are available and may be essential in successful therapy. Nocardial infections in children indicate the need for evaluation for an underlying immunological deficiency. Nocardia species should be considered as possible causative agents in immunocompromised patients with infection.
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