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Background Medically unexplained chronic fatigue states are prevalent and challenging to manage. Cognitive behavioural therapy ( CBT) and graded exercise therapy ( GET) are effective in clinical trials. The evaluation of delivery in a standard healthcare setting is rare. An integrated treatment programme with individualised allocation of resources to patients' needs was developed and implemented through an academic outpatient clinic. It was hypothesised that the programme would result in similar responses to those observed in the clinical trials. Aim To evaluate the outcomes of an integrated, 12-week CBT and GET programme delivered by exercise physiologists and clinical psychologists. Methods Consecutive eligible patients ( n = 264) who met the diagnostic criteria for chronic fatigue syndrome or post-cancer fatigue were evaluated with self-report measures of fatigue, functional capacity and mood disturbance at baseline, end-of-treatment (12 weeks) and follow-up (24 weeks). A semi-structured interview recording the same parameters was conducted pre- and post-treatment by an independent clinician. Primary outcome was analysed by repeated measures analysis of variance and predictors of response were analysed by logistic regression. Results The intervention produced sustained improvements in symptom severity and functional capacity. A substantial minority of patients (35%) gained significant improvement, with male gender and higher pain scores at baseline predicting non-response. A small minority of patients (3%) worsened. Conclusion The manualised protocol of integrated CBT and GET was successfully implemented, confirming the generally positive findings of clinical trials. Assessment and treatment protocols are available for dissemination to allow standardised management. The beneficial effects described here provide the basis for ongoing studies to optimise the intervention further and better identify those most likely to respond. [ABSTRACT FROM AUTHOR]

Computed tomography plays an important role for the evaluation of most patients with suspected renal injury after trauma. Intravenous urography is used for gross assessment of renal function in hemodynamically unstable patients. Renal injuries can be classified into four large groups: (1) minor renal contusion, lacerations, subcapsular hematoma, and small cortical infarcts; (2) major renal lacerations extending to the medulla with or without involvement of the collecting system; (3) catastrophic renal injuries including fragmentation of the kidney and renal pedicle vascular injuries; and (4) ureteropelvic junction injuries. Integration of the imaging findings of renal injury with clinical information is important to developing a treatment plan. [ABSTRACT FROM AUTHOR]

Ion-selective microelectrodes inserted into the compound eyes of Calliphora, Locusta and Apis were used to monitor the changes in extracellular concentration of Ca (Ca) brought about by a 1-min exposure to white light (maximal luminous intensity ca. 10 cd/m). In the blowfly retina such stimulation causes a decrease in Ca. At high light intensities the Ca signal is phasic, falling over about 6 s to a transient light-induced minimum (ΔCa= -6.2% ± 0.4%, n = 20, SE) and then rising to an approximately stable plateau (-3.3% ± 0.6%). In migratory locusts the light-induced minimum corresponds to a ΔCa of -13.8% ± 1.6% ( n = 10), and at the plateau the Ca decrease is-13.2% ± 1.5%. In honey-bees Ca at first decreases only slightly, by -2.6% ± 1.0% ( n = 10); by the end of the 1-min stimulus the extracellular concentration averages 33.6% ± 14.6% above the dark level. The results suggest a relationship between the position of the characteristic curve of the photoreceptor in the dark-adapted state, the occurrence of quantum bumps, and light-induced increases or decreases in Ca. Therefore the species differences might be interpreted as a consequence of differences in the intracellular dark concentration of Ca. [ABSTRACT FROM AUTHOR]

Ion-selective microelectrodes inserted into the compound eyes of Calliphora were used to monitor the changes in extracellular concentration of Ca and Na (Ca, Na) brought about by a 1-min exposure to white light (maximal luminous intensity ≈0.1 cd/cm). Using Ringer solution as the reference (Ca = 1 m M), the dark concentration of the calcium in the retina was found to be (1.4 ± 0.4) m M ( n=12). Stimulation with light reduces Ca. At intensities near maximal the Ca signal is phasic, reaching a transient minimum about 6 s after light onset $$(\Delta {\text{Ca}}_{\text{o}} {\text{ = }} - 6.28\% \pm 1.6\% ,{\text{ }}n = 20)$$ and then rising to a nearly stable plateau below the dark level (-3.3% ± 2.6%). Ca signals measured in the white-eyed mutant (chalky), which lacks pigment granules, are comparable to those in the wild type. Conclusions: (a) There are no extracellular Ca binding sites that regulate light adaptation, such as were postulated by Hochstrate and Hamdorf (1985). (b) Ca influx into the photoreceptors seems to be necessary for light adaptation, (c) The pigment granules have no major function in intracellular calcium regulation. The time course of the Na signals resembles that of the Ca signals. Because the percentage concentration change is small, light-induced extracellular Na-depletion cannot contribute to a reduced response amplitude at light adaptation. [ABSTRACT FROM AUTHOR]

Three patients with renocolic fistulas are presented. Antegrade or retrograde pyelography showed the fistula in one patient but was unsuccessful in two others. CT demonstrated perinephric inflammation extending to the colon, complex air-fluid collections within the kidney, or extension of renal contrast into the colon. CT and direct pyelography complement each other for the diagnosis of renocolic fistulas. [ABSTRACT FROM AUTHOR]