Ioannis A. Lougaris Veterans Affairs Medical Center

Subjects with hypertension are hyperinsulinemic and resistant to insulin-stimulated glucose uptake. A similar paradigm is found in the spontaneously hypertensive rat (SHR). These findings suggest the possibility that insulin resistance and hyperinsulinemia may play an important role in blood pressure regulation. Pioglitazone, a thiazolidinedione derivative, sensitizes target tissues to insulin and decreases hyperglycemia and hyperinsulinemia in various insulin-resistant animals. The purpose of this study was to assess the influence of pioglitazone administration on pre- and postprandial glucose and insulin concentrations and determine whether changes in beta-cell secretion resulted in any change in blood pressure measurements. Twelve SHR were fed custom diets ad libitum, six with and six without pioglitazone (20 mg/kg chow). Fasting and postprandial glucose levels were unaltered by pioglitazone treatment. Fasting insulin concentrations were similar at week 1, but were significantly lower (P < .01) in the pioglitazone group at weeks 3 (1.89 +/- 0.3 v7.94 +/- 1.5 ng/mL) and 4 (4.5 +/- 1.4 v9.1 +/- 0.7 ng/mL), compared with the control group. Pioglitazone also significantly (P < .01) lowered postprandial insulin concentrations after an oral glucose challenge. Systolic, mean, and diastolic blood pressures were significantly lower (P < .01), 177 +/- 3 v190 +/- 4.7 mm Hg, 162 +/- 2.1 v175 +/- 5.9 mm Hg, and 156 +/-2.1 v168 +/- 6.2 mm Hg, respectively, in the animals receiving pioglitazone versus the control group. Heart rate, body weight, serum cholesterol, and triglyceride levels were comparable between the two groups. In conclusion, pioglitazone significantly decreased fasting and postprandial insulin concentrations and effectively lowered blood pressure in the SHR.

Allogeneic and xenogeneic hematolymphoid chimerism has been achieved in large and small animals using varied techniques to circumvent immune mediated graft rejection by the recipient. We show here the establishment of long-term chimerism in normal mice transplanted in utero with human fetal hematopoietic stem cells (HSC). HSCs from fetal (13-20 weeks' gestation) human livers were injected into fetal mouse peritoneal cavities on days 11-13 of gestation. Histologic examination demonstrated human chimerism in 29% of 38 live born mice using fluorescein conjugated antibodies to both the CD45 and CD14 antigens present on human peripheral blood (PB) cells. Further investigation using flow cytometric analysis of cells from 70 mice transplanted in utero revealed 28% of mice greater than 16 weeks of age contained human cells in at least one organ at the following frequencies: 14% PB, 8% bone marrow, 8% spleen and 12% thymus. These data indicate that human fetal HSC can be engrafted into mouse fetuses. Additionally, the identification of circulating human cells 18 months following transplantation supports the engraftment and proliferation of a primitive hematopoietic progenitor.

We have previously reported prolonged hematopoietic chimerism in normal mice transplanted in utero with human fetal hematopoietic stem cells (HSC) by flow cytometry. We now further confirm the human origin of these cells by demonstrating human DNA in the marrow of one such chimeric mouse. We also examined 42 mice born after in utero transplantation with HSC enriched from human adult marrow cells. All live-born mice were treated with recombinant human growth factors. Twelve had human cells in the peripheral blood (range: 01.-2.93%). Thymic samples were positive in 3 cases. The bone marrow of 2 mice contained cells expressing human CD34 antigen. Light scatter characteristics support the presence of multilineage hematochimerism. Human IgM was present in 2 of 4 chimeric sera tested. Thus, normal mice transplanted in utero with human HSC may permit long-term engraftment and differentiation of the human HSC.

Most cases of diabetes mellitus result from decreased insulin secretion (type I, insulin-dependent) or altered insulin action (type II, insulin-independent). Another category, namely, "other" diabetes mellitus-associated conditions, is usually mentioned to distinguish this type of diabetes from the other two categories; this category includes drugs, genetic and endocrine syndromes, and pancreatic disorders. The most common pancreatic disease that causes diabetes mellitus is chronic pancreatitis that results from alcohol abuse. The clinical observation of patients at our institution with long histories of heavy alcohol intake and diabetes mellitus prompted us to review the impact of alcohol on carbohydrate metabolism. In many of these patients, it was notable that they were not obese and they had no immediate family members with diabetes mellitus, raising the possibility that alcohol-associated diabetes mellitus may be a distinct subset of non-insulin-dependent diabetes mellitus that is distinct from type II diabetes mellitus.

A visit to a physician's office may provoke an increase in blood pressure. Stress is also a well-known glycemic aggravation, and managing diabetes with ongoing stress is often difficult. Two patients with diabetes mellitus in whom anxiety and stress contributed to transient hyperglycemia that impacted adversely on their diabetes management are presented. "White coat" hyperglycemia should be suspected when the clinical glucose levels are higher than the glucose levels measured by the patient at home and the clinical glycohemoglobin levels. The recognition of white coat hyperglycemia is especially important with the recent findings that intensive therapy effectively delays the onset and slows the progression of diabetic complications in patients with insulin-dependent diabetes mellitus. Failure to appreciate white coat hyperglycemia will increase the risk of hypoglycemic episodes, some of which may be severe and life threatening.

Zinc chloride smoke bomb exposure is frequently seen in military drills, combat exercises, metal industry works, and disaster simulations. Smoke exposure presents with variety of pulmonary damage based on the intensity of the exposure. Smoke induced severe acute respiratory distress syndrome (ARDS) is often fatal and there are no standard treatment guidelines. We report the first survival of smoke induced severe ARDS in the United States (US) with prolonged use of high dose steroids (five weeks) and lung protective ventilation alone. Previously reported surviving patients in China and Taiwan required extracorporeal membrane oxygenation (ECMO) and other invasive modalities. We suggest that an extended course of high dose corticosteroids should be considered for the treatment of smoke inhalation related ARDS and should be introduced as early as possible to minimize the morbidity and mortality. We further suggest that patients with smoke inhalation should be observed in the hospital for at least 48 to 72 hours before discharge, as ARDS can have a delayed onset. Being vigilant for infectious complications is important due to prolonged steroid treatment regimen. Patients must also be monitored for critical illness polyneuromyopathy. Additionally, upper airway injury should be suspected and early evaluation by otorhinolaryngology may be beneficial.

Addison's disease secondary to metastatic cancer to the adrenal gland is underdiagnosed. Prompt diagnosis and treatment is essential and could enhance the quality of life. Cases of adrenal insufficiency produced by metastatic carcinoma are unusual, despite the frequency of carcinomatous metastases to the adrenal glands. The clinical features of adrenal insufficiency are relatively nonspecific and can be easily overlooked in a patient with a malignant neoplasm. We report herein the case of a middle-aged man who presented with adrenal insufficiency in association with pancreatic carcinoma. To our knowledge, this is the first reported case of adrenal insufficiency occurring with adenocarcinoma of the pancreas.

Hypertension is a major risk factor for coronary artery disease, stroke, renal failure, and peripheral vascular disease. The importance of preventing hypertension and controlling blood pressure in patients with hypertension is well established and is associated with reduced cardiovascular morbidity and mortality rates. Treatment guidelines should consider the merits of dietary changes in addition to pharmacologic therapy in the control of mild hypertension.

BACKGROUND: Fracture absolute risk assessment (FARA) is recommended for guiding osteoporosis treatment decisions in males. The best strategy for applying FARA in the clinic setting is not known. OBJECTIVES: We compared 2 FARA tools for use with electronic health records (EHRs) to determine which would more accurately identify patients known to be high risk for fracture. Tools evaluated were an adaptation of the World Health Organization's Fracture Risk Assessment Tool used with electronic data (eFRAX) and the Veterans Affairs (VA)-based tool, VA-FARA. METHODS: We compared accuracies of VA-FARA and eFRAX for correctly classifying male veterans who fractured and who were seen in the VA's Sierra Pacific Network in 2002-2013. We then matched those cases to nonfracture controls to compare odds of fracture in patients classified as high risk by either tool. RESULTS: Among 8740 patients, the mean (SD) age was 67.0 (11.1) years. Based on risk factors present in the EHR, VA-FARA correctly classified 40.1% of fracture patients as high risk (33.0% and 34.6% for hip and any major fracture, respectively); eFRAX classified 17.4% correctly (17.4% for hip and 0.2% for any major fracture). Compared with non-high-risk patients, those classified as high risk by VA-FARA were 35% more likely to fracture (95% CI = 23%-47%; P < 0.01) compared with 17% for eFRAX (95% CI = 5%-32%; P < 0.01). CONCLUSIONS: VA-FARA is more predictive of first fracture than eFRAX using EHR data. Decision support tools based on VA-FARA may improve early identification and care of men at risk.

Journal Article Central Nervous System Inflammation in the Eosinophilia-Myalgia Syndrome Get access J. S. PIXLEY, J. S. PIXLEY *Department of Medicine, University of Nevada School of Medicine, lonnis A. Lougaris Medical CenterReno, NV 89520 Search for other works by this author on: Oxford Academic PubMed Google Scholar J. M. EATON, J. M. EATON Search for other works by this author on: Oxford Academic PubMed Google Scholar R. M. ZWEIG R. M. ZWEIG ‡Department of Neurology, LSU Medical CenterBox 33932, Shreveport, LA 71130-3932, U.S.A. Search for other works by this author on: Oxford Academic PubMed Google Scholar Rheumatology, Volume 32, Issue 2, February 1993, Page 174, https://doi.org/10.1093/rheumatology/32.2.174-a Published: 01 February 1993 Article history Accepted: 07 October 1992 Published: 01 February 1993

= 47 years) experiencing anxiety, depression, or adjustment difficulties who were recruited from Veterans Health Administration primary care. Using mixed methods, we assessed mental health symptoms and functioning from pre- to posttreatment and 3-month follow-up as well as treatment feasibility, acceptability, and satisfaction. MSE was feasible (89% engaged), and patients reported high treatment satisfaction. Pre- to posttreatment changes were promising, with medium-to-large effect sizes, and treatment gains generally remained stable at 3-months. Mixed methods data showed increased awareness of emotions and more use of adaptive coping strategies after MSE. Findings suggest further research evaluating effectiveness and implementation is warranted, as this is the briefest version of group Unified Protocol that has been tested thus far and can help to efficiently increase access to mental health treatment. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Introduction:Yellow nail syndrome (YNS) is a rare clinical disease that commonly affects adults over 50, with an estimated prevalence of less than one in one million (1). Approximately 400 cases have been reported in the medical literature (2). Heller first described it in 1927, followed by Samman and White’s case series of 13 patients in 1964 (3,4). YNS presents as a classic triad of yellowish nail discoloration, lymphedema, and respiratory tract involvement (5).The exact pathogenesis of the disease is unknown. It was initially thought to be a genetic disease, inherited in an autosomal dominant fashion, until a case series of 11 patients with YNS revealed only one patient had a positive family history (6). The most widely accepted theory is the dysfunction of the lymphatic system. Lymphoscintigraphy imaging has shown abnormal lymphatic transport in YNS patients compared to primary lymphedema (1, 2). Other proposed mechanisms include increased microvascular permeability in the pleura, which contributes to the clinical manifestations of YNS (7). Protein leakage has also been linked to YNS (8). While there have been numerous associations, the exact pathogenesis remains multifactorial and unclear, involving a combination of genetic, environmental, and systemic factors.Due to the rarity of the disease, it is often misdiagnosed, leading to unnecessary tests and delayed treatment. Hence, we report a patient with the classic triad of YNS and a unique presentation of unilateral pleural effusion in contrast to the most commonly seen bilateral pleural effusion associated with YNS.

Journal Article Reply Get access Syed Bilgrami, Syed Bilgrami Jean Marie Colbert Bone Marrow Transplant Center, University of Connecticut School of Medicine and Dental Medicine, Farmington, Connecticut; and the Department of Hematology Research, Department of Veterans Affairs-Ioannis A. Lougaris Medical Center, Reno, Nevada Search for other works by this author on: Oxford Academic PubMed Google Scholar Joao L. Ascensao Joao L. Ascensao Jean Marie Colbert Bone Marrow Transplant Center, University of Connecticut School of Medicine and Dental Medicine, Farmington, Connecticut; and the Department of Hematology Research, Department of Veterans Affairs-Ioannis A. Lougaris Medical Center, Reno, Nevada Reprints or correspondence: Dr. Joao L. Ascensao, Department of Veterans Affairs-Ioannis A. Lougaris Medical Center, Department of Hematology Research, 1000 Locust Street, Reno, Nevada 89520. Search for other works by this author on: Oxford Academic PubMed Google Scholar Clinical Infectious Diseases, Volume 17, Issue 2, August 1993, Page 285, https://doi.org/10.1093/clinids/17.2.285 Published: 01 August 1993