Search

OBJECTIVE: To evaluate whether extremely low gestational age neonates (ELGANs) randomized to erythropoietin have better or worse kidney-related outcomes during hospitalization and at 22–26 months corrected gestational age (cGA) compared with those randomized to placebo. STUDY DESIGN: We performed an ancillary study to a multicenter double-blind, placebo-controlled randomized clinical trial of erythropoietin in ELGANs. RESULTS: The prevalence of severe (stage 2 or 3) acute kidney injury (AKI) was 18.2%. We did not find a statistically significant difference between those randomized to erythropoietin vs. placebo for in-hospital primary (severe AKI) or secondary outcomes (any AKI and serum creatinine [SCr]/ cystatin C values at days 0, 7, 9 and 14). At 22–26 months cGA, 16% of the cohort had an estimated glomerular filtration rate (eGFR) 30 mg/g, 23% had a systolic blood pressure (SBP) >95(th) percentile for age, and 40% had a diastolic blood pressure (DBP) >95(th) percentile for age. SBP >90(th) percentile occurred less often among recipients of erythropoietin (p95(th) percentile or DBP >90(th) or >95(th) percentiles. CONCLUSIONS: ELGANs have high rates of in-hospital AKI and kidney-related problems at 22–26 months cGA. Recombinant erythropoietin (rhEpo) may protect ELGANs against long-term elevated SBP, but does not appear to protect from AKI, low eGFR, albuminuria or elevated DBP at 22–26 months cGA.

Background: In recent years, there has been a documented increase in the number of professional baseball players on the disabled list and the total number of days on the disabled list. Pitchers account for the largest number of disabled list reports. Purpose: To examine the relationship between magnetic resonance imaging (MRI) findings in asymptomatic professional pitchers and subsequent time on the disabled list (DL). Study Design: Cohort study (Prognosis); Level of evidence, 2. Methods: A total of 21 asymptomatic professional pitchers from a single Major League Baseball (MLB) organization underwent preseason MRIs of their dominant shoulder from 2001 to 2010. Asymptomatic was defined as no related DL stays in the 2 seasons before the MRI. These studies were reevaluated by a fellowship-trained musculoskeletal radiologist who was blinded to patient name, injury history, and baseball history. A second investigator who was blinded to the MRI results collected demographic data, total career number of innings pitched, and any subsequent DL reports for each subject. Results: The mean age at the time of MRI was 29.04 years (range, 20-39 years). Eleven of 21 pitchers had a rotator cuff tear (RCT): 9 had an articular surface tear (AST), and 2 had a full-thickness rotator cuff tear (FTT). Ten had superior labral anterior posterior (SLAP) tears, and 13 had either anterior or posterior labral tears. There was a statistically significant relationship between the number of innings pitched and presence of an RCT (AST + FTT). The mean number of career innings pitched by those with an RCT was 1014 compared with a mean of 729 innings pitched in pitchers without an RCT ( P < .01). In addition, the number of career innings pitched was moderately correlated with presence of RCT ( r = 0.46) and presence of superior and anterior/posterior labral tears ( r = 0.43). There were no statistically significant findings between any single preseason MRI finding and subsequent time on the DL. Conclusion: The MRI findings in asymptomatic MLB pitchers do not appear to be related to near future placement on the DL. However, there was a significant difference in numbers of innings pitched between pitchers who had an RCT and those who did not and a moderate correlation between innings pitched and the presence of RCT as well as the presence of labral lesions. This finding supports the notion that RCT and labral injury in pitchers may result from repetitive overhead motion with subsequent strain on the rotator cuff tendons and glenoid labrum. Asymptomatic shoulder lesions in professional baseball pitchers appear to be more frequent than previously thought.

Fibrosing retroperitoneal changes can mimic malignant tumours. The correlation with beta-blockers has long been known where practolol was the prototype agent. It is now possible to report supradiaphragmatic occurrence of a similar pathology and its link with later generation beta adrenergic receptor blocking drugs leading to a diagnosis of lymphoma. This rare association needs to be included in the differential diagnosis of mass lesions in both abdomen and chest.

OBJECTIVE: To identify rates of overweight (BMI ≥85(th) percentile) and obesity (BMI ≥95(th) percentile) at 6-7 years of age and associated risk factors among extremely preterm infants born at < 28 weeks of gestation. STUDY DESIGN: Anthropometrics, blood pressure, and active and sedentary activity levels were prospectively assessed. Three groups were compared, those with BMI≥85(th) percentile (overweight or obese for age, height and sex) and ≥95(th) percentile (obese) versus 85(th) percentile), central fat (waist circumference> 90(th) percentile), spent more time in sedentary activity (20.5 versus 18.2 versus 16.7 hours/week), and had either systolic and/or diastolic hypertension (24% versus 26% versus 14 %) respectively. Post discharge weight gain velocities from 36 weeks postmenstrual age (PMA) to 18 months, and 18 months to 6-7 years were independently associated with BMI ≥85(th) percentile whereas weight-gain velocity from 18 months to 6-7 years was associated with obesity. CONCLUSIONS: One in five former extremely preterm infants is overweight or obese and has central obesity at early school age. Post discharge weight gain velocities were associated with overweight and obesity. These findings suggest the obesity epidemic is spreading to the most extremely preterm infants. Trial registration ClinicalTrials.gov NCT00063063 and NCT0000

In lithium-treated patients, polyuria increases the risk of dehydration and lithium toxicity. If detected early, it is reversible. Despite its prevalence and associated morbidity in clinical practice, it remains underrecognized and therefore undertreated. The 24-hour urine collection is limited by its convenience and practicality. This study explores the diagnostic accuracy of alternative tests such as questionnaires on subjective polyuria, polydipsia, nocturia (dichotomous and ordinal responses), early morning urine sample osmolality (EMUO), and fluid intake record (FIR). This is a cross-sectional study of 179 lithium-treated patients attending a general adult and an old age psychiatry service. Participants completed the tests after completing an accurate 24-hour urine collection. The diagnostic accuracy of the individual tests was explored using the appropriate statistical techniques. Seventy-nine participants completed all of the tests. Polydipsia severity, EMUO, and FIR significantly differentiated the participants with polyuria (area under the receiver operating characteristic curve of 0.646, 0.760, and 0.846, respectively). Of the tests investigated, the FIR made the largest significant change in the probability that a patient experiences polyuria (2000 mL/24 hours; interval likelihood ratio, 0.18 and3500 mL/24 hours; interval likelihood ratio, 14). Symptomatic questioning, EMUO, and an FIR could be used in clinical practice to inform the prescriber of the probability that a lithium-treated patient is experiencing polyuria.

BackgroundLow cholesterol may act as a peripheral marker for parasuicide.AimsTo examine the relationship between total serum cholesterol and psychological parameters in parasuicide.MethodTotal serum cholesterol and self-rated scores for impulsivity, depression and suicidal intent were measured in 100 consecutive patients following parasuicide, pair-matched with normal and psychiatric control groups.ResultsBackward, stepwise multiple regression analysis revealed a significantly lower mean cholesterol in the parasuicide population (PPConclusionsThe data confirm previous reports of low cholesterol in parasuicide. This is the first reported investigation of the construct of impulsivity in relation to cholesterol. We hypothesise that the reported increased mortality in populations with low cholesterol may derive from increased suicide and accident rates consequent on increased tendencies to impulsivity in these populations.