Dynamic study of renal function with radioimmunoassay technique (RIA) in burn patients

Alb, beta 2-m, IgG in serum and urine were determined in 52 burn patients (from January 1993 to December 1994) with RIA technique. The results revealed that there was no obvious connection between the area of burn and the alteration in these parameters (P > 0.05). Our findings indicated a positive correlation between the depth of burn and impairment in the renal function. The recovery of renal function was gradual, and that of glomerulus was earlier than renal tubules. Monitoring of renal function with RIA technique showed a higher sensitivity and accuracy than routine examinations, and it might play an important role in the treatment of burned patients in different periods.     

The part of vaginal plastic operations played in the incidence of thromboembolic disease (author''s transl)

Histocompatibility (HL-A) phenotypes of 44 unrelated white patients from the greater Boston area with amyotrophic lateral sclerosis (ALS) and 200 white controls were compared. In the overall ALS group, an increased frequency of HL-A3 was noted (43% vs 25%, P less than .05). Thirty-eight patients had rapidly progressive disease; among this group the HL-A3 incidence was 50% (P less than .005). Six patients had slowly progressive disease, none had HL-A3, and five had HL-A12. The HL-A antigens may link with disease severity in ALS.     

Skeletal muscle function at low work level as a model for daily activities in patients with chronic heart failure

AIM: Metabolic exercise abnormalities have been reported in chronic heart failure patients. This study sought to evaluate whether these abnormalities affected daily activity. METHODS AND RESULTS: In 16 patients with moderate-to-severe chronic heart failure and in eight controls we measured femoral flow (thermodilution) and metabolism (glucose, lactate, free fatty acids, blood gas values) at rest and during a constant load of 20 W, which may mimic a daily activity. At rest, chronic heart failure patients had a leg flow similar to controls, but showed a higher leg oxygen consumption (4.6 +/- 0.6 vs 2.6 +/- 0.4 ml.min-1; P < 0.05), a higher arteriovenous oxygen difference (7.2 +/- 0.5 vs 5.4 +/- 0.7 ml.dl-1; P < 0.05), and a lower femoral vein pH (7.37 +/- 5.03 vs 7.42 +/- 0.01; P = 0.01). At 20 W, chronic heart failure patients had a leg flow similar to controls, but showed increased lactate release (from resting 11.7 +/- 33 to 142 +/- 125 micrograms.min-1 P < 0.0001 vs controls, from resting 5.7 +/- 15.4 to 50 +/- 149 micrograms.min-1 ns), higher arterial concentration of free fatty acids (781 +/- 69 vs 481 +/- 85 mumol.l-1; P < 0.01), lower femoral vein HCO3 (24.1 +/- 2.6 vs 26.3 +/- 1.7 mmol.l-1; P < 0.05) and base excess (-2.3 +/- 2.3 vs -0.24 +/- 1.7 mmol.l-1; P = 0.01). CONCLUSION: In chronic heart failure patients, the important cellular metabolic alterations already present at rest partially affect daily activities, owing to a further decrease in the efficiency of muscle metabolic processes, and may preclude tolerance of heavier activities. Such alterations appear, at least in part, independent of peripheral haemodynamic responses to exercise.     

The course of kidney function in type 2 (non-insulin-dependent) diabetic patients with diabetic nephropathy

We evaluated the impact of some putative progression promoters on kidney function in albuminuric Type 2 (non-insulin-dependent) diabetic patients with biopsy-proven diabetic glomerulosclerosis. Twenty-six patients (1 female) with a mean age of 52 (standard error 2) years and a known mean duration of diabetes of 9 (1) years were followed-up prospectively for a mean of 5.2 (range 1.0-7.0) years. Twenty-one patients received antihypertensive treatment. During the observation period the glomerular filtration rate decreased from 83 (24-146) to 58 (2-145) ml.min-1 x 1.73 m-2 (mean (range)) (p < 0.001). The mean rate of decline in glomerular filtration rate was 5.7 (-3.5 to 22.0) ml/min per year. Albuminuria increased from 1.2 (0.3-7.2) to 2.3 (0.4-8.0) g/24 h (geometric mean (range)) (p < 0.001). Arterial blood pressure remained unchanged: 162/93 (SE 4/3) and 161/89 (4/2) mm Hg. Univariate analysis showed the rate of decline in glomerular filtration rate to correlate with systolic blood pressure (r = 0.71, p < 0.001), mean blood pressure (r = 0.56, p < 0.005), albuminuria (r = 0.58, p < 0.005) and the initial glomerular filtration rate (r = -0.49, p < 0.02). The rate of decline in glomerular filtration rate did not correlate significantly with dietary protein intake, total cholesterol, high-density lipoprotein cholesterol or HbA1c. Three patients died from uraemia and four patients died from cardiovascular disease. Two patients required renal replacement therapy at the end of the observation period. Our prospective observational study revealed that one-fifth of the patients developed end-stage renal failure during the 5-year observation period.(ABSTRACT TRUNCATED AT 250 WORDS)     

On the structure and function of a neurohemal organ in the eye cavity of Eledone cirrosa (Cephalopoda)

The subpeduncualte lobe of the octopod brain produces a hormone that is released into the orbit. The hormone was extracted from Eledone cirrosa and assayed on the isolated perfused heart of the same species. It has a remarkable effect on amplitude, beat frequency and blood pressure; compared to equivalent extracts of posterior salivary gland it is about 70 times more effective. The substance is not a biogenic amine.     

The utilities and outlooks of MR cholangiography (MRCP) as a non contrast and noninvasive technique

The objective of this study was to determine the metabolic fate and disposition of the antitumor camptothecine derivative irinotecan (CPT-11). Ten patients with histological proof of malignant solid tumor received 200 mg/m2 CPT-11 as a 90-min i.v. infusion, followed by a 1.5-h i.v. infusion of cisplatin (60 or 80 mg/m2). Plasma, urine, and feces were collected for 56 h and analyzed by a specific reversed-phase high-performance liquid chromatographic assay for the parent drug and all four metabolites positively identified to date: SN-38; its beta-glucuronide conjugate, SN-38 beta-glucoronide (SN-38G); 7-ethyl-10-[4-N-(5-aminopentanoic acid)-1-piperidino]-carbonyloxycamptothecine (APC); and 7-ethyl-10-[4-N-(1-piperidino)-1-amino]-carbonyloxycamptothecine (NPC). A three-exponential decline was observed in plasma for all compounds, with a clear predominance of the parent drug [25.6+/-5.71 microM x h (CPT-11) versus 15.8+/-3.51 microM x h (total metabolites)]. Total urinary excretion was 28.1+/-10.6% of the dose, with unchanged CPT-11 and SN-38G as the main excretion products. Whereas renal clearance of SN-38 was only a minor route of drug elimination, fecal concentrations of this compound were unexpectedly high (on average, 2.45% of the dose), suggestive of intestinal hydrolysis of SN-38G by bacterial beta-glucuronidase. CPT-11 and the other metabolites could also be identified from fecal extracts, with a very minor contribution overall of the cytochrome P-450-mediated compounds 7-ethyl-10-[4-N-(1-piperidino)-1-amino]-carbonyloxycamptothecine and 7-ethyl-10-[4-N-(5-aminopentanoic acid)-1-piperidino]-carbonyloxycamptothecine. Surprisingly, fecal excretion accounted for only 24.4+/-13.3% of the dose, leading to a total excretion of approximately 52%. These data indicate that half of the dose in urine and feces may constitute some further unknown nonextractable or nonfluorescent metabolites. The findings from this study should be of importance as a guide to further therapeutic evaluation of this drug.     

Polycythemia vera treated with pipobroman as single agent: low incidence of secondary leukemia in a cohort of patients observed during 20 years (1971-1991)

The 'gold standard' for the treatment of polycythemia vera (PV) is to date undefined. We performed a retrospective analysis to evaluate the outcome of a cohort of PV patients treated with pipobroman (PB) at a single institution during a period of 20 years (November 1971-October 1991). During this period, a total of 366 adult PV patients were diagnosed according to Polycythemia Vera Study Group (PVSG) criteria. Of these, only 199 (54%) were treated with PB: 92 were males and 107 females, median age was 63.0 years (range 25.2-87.3 years). Major clinical characteristics at onset were as follows: 34 (17%) patients had splenomegaly >3 cm below costal margin, 70 (35%) had platelets >600,000/mm3, 79 (40%) had white blood cells >12,000 mm3; 97 (49%) had hypertension, 83 (42%) had minor neurological symptoms (as vertigo, headache, paresthesias), 33 (17%) had pruritus and 27 (13%) had thrombotic features. All patients received PB at the dosage of 1 mg/kg/day until response was achieved (hematocrit value <50% in males and <45% in females). Thereafter treatment was given according to toxicity and maintenance of response. All patients were phlebotomized before starting treatment (mean number of phlebotomies performed: three, range 2-4) and 47 of them received PB when hematocrit value was already reduced at response levels: therefore, while all patients are evaluable for acute and long-term toxicity, only 152/199 (76.4%) patients are evaluable for response to PB. During a median time of 2 months, all these 152 patients achieved the response; as maintenance, 128/199 (64.3%) patients were managed with PB alone and 71/199 (35.7%) patients received phlebotomies occasionally. Sixty-one out of 199 (30.6%) patients developed disease-related complications (25 neurological symptoms, 21 thrombotic complications, 12 cardiovascular problems, three hepatic failures). Eleven (5.5%) patients developed acute myelogenous leukemia (AML) after a median time of treatment of 89 months (range 33-188 months), 11 (5.5%) patients developed myelofibrosis (median time from treatment 71 months, range 31-182 months) and in six (3%) patients cancer occurred (median time from treatment 85 months, range 13-118 months). The cumulative risk of leukemia in PV was 2% (95% CI: 0-4%) and 6% (95% CI: 1-11%) at 5 and 10 years respectively; the cumulative risk of myelofibrosis was 2% (95% CI: 1-5%) and 9% (95% CI: 3-15%) at 5 and 10 years, respectively. As of May 1996, 33 (16.6%) patients are lost to follow-up, 40 (20.1%) are dead and 126 (63.3%) are alive with a median overall survival of 191 months. In conclusion, this retrospective analysis confirms the efficacy and safety of PB in PV patients and its low leukemogenic role; prospective studies are needed to evaluate the real impact of PB in the treatment of PV.     

Fungal microflora biodiversity as a function of pollution in Oued Sebou (Morocco)

An inventory of the fungal microflora present in sediments collected at 11 sites along Oued Sebou has been established. The influence of some climatic parameters (temperature, rainfall) and of pollution on the composition of the fungal communities has been questioned. Emericella nidulans, Eurotium amstelodami, Neosartotya fisheri var. glabrum (Ascomycetes), Dreschslera biseptata (Dematiaceae), Penicillium citrinum (Mucedinaceae) and Phoma sp. (Sphaeropsidale) can be considered as strains sensitive to pollution. Penicillium janthelinum, Trichoderma koningii (Mucedinaceae) and Candida albicans (Yeast) were found only at the most polluted sites; Talaromyces flavus (Ascomycete) Rhodotorula rubra, Saccharomyces cerevisiae (Yeasts) and Fusarium oxysporum (Tuberculariales) were more often found at heavily polluted sites than at lightly polluted ones.     

Lipoprotein(a) as a risk predictor for cardiac mortality in patients with acute coronary syndromes

AIMS: Raised lipoprotein(a) concentrations are considered to be a risk factor for atherothrombotic diseases. We examined whether baseline concentrations were a risk factor for an adverse outcome in patients admitted with acute coronary syndromes. METHODS AND RESULTS: Five hundred and nineteen patients admitted with suspected acute coronary syndromes were studied and followed prospectively for a median of 3 years. The prognostic significance of a baseline lipoprotein(a) concentration of > or = 30 mg x dl(-1) or lower for subsequent cardiac death was assessed in patients with myocardial infarction (266) and unstable angina (197) and compared with other variables in regression models. In patients with myocardial infarction, a baseline lipoprotein(a) concentration of > or =30 mg x dl(-1) was associated with a 62% increase in subsequent cardiac death compared to the lower concentration group (29.8% vs 18.6%, Log rank P=0.04). In a multivariate regression model a baseline lipoprotein(a) concentration of > or = 30 mg x dl(-1) retained its significance as an independent predictor of cardiac death (P=0.037). In patients with unstable angina, baseline concentrations of > or = 7.9 mg x dl(-1) were found to be significant predictors of cardiac death in univariate (P=0.021) and multivariate (P=0.035) regression models. CONCLUSION: Baseline lipoprotein(a) concentrations in patients admitted with acute coronary syndromes are associated with an increased risk of cardiac death. For patients with myocardial infarction a concentration of > or = 30 mg x dl(-1) appears appropriate as a risk discriminator; for patients admitted with unstable angina, however, much lower concentrations of lipoprotein(a) appear to be prognostically important.     

The results and failures of creating a pelvic reservoir in oncology (surgery, urology)

The results of abdominal and pelvic pouch operations are described in surgical and urological material. The lateral ileal pouch (Fonkalsrud) was used in 8 patients with diffuse colonic polyposis and in 4 cases of colitis ulcerosa. The second step of this two-phase operation was completed in 7 patients. Five complications were observed. One patient died of faecal peritonitis. Some sort of pouch operation was carried out in 22 patients after radical cystectomy in urological practice. The indication was tumour of the urinary bladder in 18, tuberculosis in 2 and interstitial cystitis in 2 cases. The distribution of the different types of reconstructions was as follows: Kock's pouch in 11, Mainz-pouch I in 5, and Mainz-pouch II in 6 patients. Early complications were observed in 3 cases with kock's reservoir, in 2 with Mainz I and in 2 with Mainz II intervention. Overnight incontinence appeared as a late complication in 30-60% of the cases. One of these patients died of a suture-line insufficiency after a Mainz-I substitution.     

Age-related changes of B-cell immune function in patients with subacute myelo-optico-neuropathy (SMON)

Several kinds of immunological abnormalities have been found more frequently in patients with subacute myelo-optico-neuropathy (SMON). To investigate whether the B-cell immune system is implicated in aging in patients with SMON, we examined serum levels of immunoglobulin including IgG, IgM, and IgA, and the number of CD20+ cells (B lymphocytes) and CD20+ CD23+ cells (activated B lymphocytes) using flow cytometry, and compared them with those in age-matched controls. We also investigated whether the number of HLA-DR+ cells was correlated with those of CD20+ cells, CD20+ CD23+ cells, or HLA-DR+CD3+ cells (activated T lymphocytes) in patients with SMON. Serum levels of IgG, IgM and IgA were decreased with aging both in the patients with SMON and in the controls, and no significant difference was found between the two groups. Although the patients with SMON tended to show higher levels of CD20+ and CD20+ CD23+ cells than the age-matched controls, there were no significant differences between the two groups. The number of HLA-DR+ cells was correlated not with that of CD20+ cells or CD20+ CD23+ cells, but with that of HLA-DR+CD3+ cells. In patients with SMON, it is likely that the B-cell immune system is mainly implicated in the effect of aging, but it is unlikely that other factors than aging are associated with the B-cell immune system. The increase in the number of HLA-DR+ cells associated with aging in patients with SMON reflects the increase in the number of activated T lymphocytes, and is not correlated with the changes of B lymphocytes.     

The management of massive pneumocephalus and cerebrospinal fluid rhinorrhoea as a consequence of biopsy in a patient with inverted papilloma

Nasal polypectomy is a common ENT operation. Cerebrospinal fluid (CSF) rhinorrhoea and pneumocephalus are rare complications. We present a patient who developed both these complications after biopsy of nasal polyps which subsequently proved to be an inverted papilloma. He had a defect in the ethmoid roof, which was repaired. Whilst endoscopic repair of CSF leak is increasing in popularity, in this patient because of his pathology and difficulty of access a more traditional lateral rhinotomy approach was made with a successful outcome. An overview of the management of these complications is presented.     

Calcified subcutaneous nodules in patients with chronic renal failure as a result of injections with nadroparin (Fraxiparine)

We present a case of AL-type amyloidosis involving pulmonary parenchyma and hilar and mediastinal lymph nodes in a patient with Waldenstr?m's macroglobulinemia. Direct infiltration of pulmonary parenchyma by lymphocytes and plasma cells is an important factor in the etiology and pathogenesis of pulmonary manifestations of the disease. Despite detailed examination, we did not find amyloid depositions in any extrapulmonary site.     

High incidence of admissions for schizophrenia in Surinam patients in The Netherlands not caused by preferential immigration of (pre)schizophrenic patients

OBJECTIVE: To answer the question whether positive selection of (pre)schizophrenic Surinams in Surinam before emigration to the Netherlands can explain the high admission rates for schizophrenia of Surinams in the Netherlands. DESIGN: Retrospective research. SETTING: 's Lands Psychiatrisch Ziekenhuis (National Psychiatric Hospital) Paramaribo, Surinam (LPZ). METHOD: The Netherlands Central Bureau of Statistics in Voorburg and the Central Registry Office in Paramaribo provided data on emigration to the Netherlands of the Surinam population and on remigration. Files of (pre)schizophrenic patients were selected from the records of LPZ. Subsequently, these patients were traced and their pattern of migration was studied. Using the chi 2 test the significance of observed differences was assessed. RESULTS: Surinam (pre)schizophrenic patients did not emigrate more frequently to the Netherlands (6.3%) compared with the Surinam population in general (9.6%) and they remigrated more frequently to Surinam than the Surinams in general. CONCLUSION: The positive selection hypothesis must be rejected.     

The adaptive capacities of patients with panic disorders (a psychophysiological study)

Contingent-negative deviation (CND) and orientational reaction (OR) were studied in 9 women suffering from typical (according to DSM-III-R) panic disorders (PD) and 12 healthy females. CND recording was made after giving neutral (70 dB, 1000 Hz) and stress (120 dB, 2000 Hz) pairs of sounds. Patients with PD were divided in two groups depending upon CND amplitudes. The first group (4 patients) was distinguished from healthy individuals by high CND amplitude (which significantly decreased after reaction on stress sound), by delay of extinction of cutaneogalvanic reaction (CGR) and by higher electromyogram amplitude. The second group (5 patients with more severe course of PD) was characterized by low amplitudes of CND and electromyogram, by absence of changes in CND after stress sound, by delay of extinction of CGR and nonspecific response. Above-mentioned data were evidence of psychophysiological heterogeneity of typical PD. The results were interpreted from a position of adaptive abilities of patients with PD, using ineffective and immature psychophysiological strategies of overcoming stress.     

The impact of social comparison information on motivation in patients with diabetes as a function of regulatory focus and self-efficacy.

Objective: Our aim was to determine whether the impact of upward and downward social comparison information on individuals' motivation to manage their diabetes is dependent on their regulatory focus (promotion or prevention focus) and self-efficacy. Design: The hypotheses were examined in a cross-sectional study. Patients with diabetes (N = 234) read a fictitious interview with a fellow patient, either an upward or a downward target, and they filled out questionnaires. Main Outcome Measures: Motivation to work on diabetes regulation. Results: High promotion-focused patients reported more motivation than low promotion-focused patients when confronted with the upward target (positive role model). High prevention-focused patients reported more motivation than low prevention-focused patients when confronted with the downward target (negative role model). This latter finding was qualified by patients' self-efficacy, as it applied only to patients with relatively high levels of self-efficacy. Conclusion: The current study highlights the importance of considering individual differences when using role models to encourage self-care activities in persons with diabetes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)