DETERMINATION OF GLOMERULAR FILTRATION RATE IN THE NEWBORN Comparison between Results Obtained by the Single Injection Technique without Collection of Urine and the Standard Clearance Technique

Determination of glomerular filtration rate was performed in fifteen infants by both the single injection technique and the standard inu-lin clearance technique. Eleven infants were fasted for four hours before the study. In those patients there was a good accordance between the two methods for determination of glomerular filtration rate. Four infants received breast milk or formula within 1 hour before the single injection procedure was started. In those infants there was a considerable over-estimation of glomerular filtration rate with the single injection technique. The error of the method introduced by recent feeding is discussed.     

Autoxidation of N-hydroxyphenylalkylamines: the inhibitory effect of some anions on copper catalysed autoxidation of N-hydroxyphentermine*

The inhibitory effect of certain electrolytes and buffers on the copper catalysed autoxidation of N-hydroxyphentermine (2-hydroxylamino-2-methyl-1-phenylpropane) has been investigated. The presence of ions such as SO₄^2?, Cl^? or Br^? markedly reduced the rate of oxidation. Phosphate and carbonate buffers had a similar effect with halides and phosphate buffers being the most inhibitory. The occurrence of 2-methyl-2-nitro-1-phenylpropane and 2-methyl-1-phenylpropene-(1) as secondary oxidation products was also established.     

Secretion rate, buffer effect and number of lactobacilli and Streptococcus mutans of whole saliva of cigarette smokers and non-smokers

Abstract – Secretion rate and buffer effect of resting and stimulated whole saliva, and number of lactobacilli and S. mutans in stimulated whole saliva were determined for 182 subjects, of whom 109 were cigarette smokers. For secretion rate, no difference between smokers and non-smokers was observed. The median buffer effect was significantly lower in smokers. The median numbers of lactobacilli and S. mutans were significantly higher in saliva of smokers. The number of lactobacilli was significantly correlated with number of cigarettes smoked per day. About 40% of the smokers had 10⁶ S. mutans CFU/ml, which was more than twice that of non-smokers. In a complementary study on 20 smokers, the immediate influence of cigarette smoking on secretion rate and buffer effect of stimulated whole saliva was investigated for 1 h after smoking. No significant effect was found.     

Bridging a Temporary High Risk of Sudden Arrhythmic Death. Experience with the Wearable Cardioverter Defibrillator (WCD)

The implantable cardioverter defibrillator (ICD) is able to reduce sudden arrhythmic death in patients who are considered to be at high risk. However, the arrhythmic risk may be increased only temporarily as long as the proarrhythmic conditions persist, left ventricular ejection fraction remains low, or heart failure prevails. The wearable cardioverter defibrillator (WCD) represents an alternative approach to prevent sudden arrhythmic death until either ICD implantation is clearly indicated or the arrhythmic risk is considered significantly lower or even absent. The WCD is also indicated for interrupted protection by an already implanted ICD, temporary inability to implant an ICD, and lastly refusal of an indicated ICD by the patient. The WCD is not an alternative to the ICD, but a device that may contribute to better selection of patients for ICD therapy. The WCD has the characteristics of an ICD, but does not need to be implanted, and it has similarities with an external defibrillator, but does not require a bystander to apply lifesaving shocks when necessary. The WCD was introduced into clinical practice about 8 years ago, and indications for its use are currently expanding. This article describes the technological aspects of the WCD, discusses current indications for its use, and reviews the clinical studies with the WCD. Additionally, data are reported on the clinical experience with the WCD based on 354 patients from Germany hospitalized between 2000 and 2008 who wore the WCD for a mean of 3 months. (PACE 2010; 33:353–367)     

Importance of Growth Hormone for Blood Glucose Regulation Following Insulin-induced Nocturnal Hypoglycemia in Insulin-dependent Diabetes Mellitus

ABSTRACT The effect of growth hormone (GH) on the glucose homeostasis following nocturnal hypoglycemia was studied between 4 a.m. and noon in eight male patients with insulin-dependent diabetes mellitus (IDDM) by a somatostatin (250 μg/h)-insulin (0.4 mU/kg/min)-glucose (6 mg/kg/min)-infusion test (SIGIT). The patients participated in two experiments in which hypoglycemia at 4 a.m. was induced by i.v. insulin (1.5 mU/kg/min). In both experiments the endogenous secretion of GH was suppressed by somatostatin (250 μg/h) and glucagon (0.5 ng/kg/min) was given as substitute for the somatostatin-induced suppression of endogenous glucagon secretion. GH (20 mU/kg/h) or saline was given for 60 min from nadir blood glucose in random order. Mean nadir glucose values were the same in both studies (1.7 ± 0.2 vs. 1.7 ± 0.1 mmol/l) and no differences were registered in plasma-free insulin, glucagon and the responses of adrenaline and Cortisol to hypoglycemia. The infusion of GH resulted in plasma GH levels of about 50 μg/l at the end of the infusion, thereafter decreasing to low or immeasurable levels within 2 hours. Infusion of GH evoked a marked hyperglycemia within 4 hours. It is concluded that when hypoglycemia is accompanied by a transient increase in plasma GH, insulin resistance occurs after a lag period of approximately 4 hours and that this effect persists for at least another 4 hours.     

Glibenclamide Improves the Response to Insulin Treatment in Non-insulin-dependent Diabetics with Second Failure to Sulfonylurea Therapy

ABSTRACT The effect of combined insulin-glibenclamide therapy on glucose control was evaluated in a double-blind placebo controlled study of 20 patients with non-insulin-dependent diabetes mellitus (NIDDM) and second failure to oral antidiabetic therapy with glibenclamide or glipizide. After an observation period of 1–3 months, insulin treatment was initiated which resulted in rapid improvement of the glycemic control within 6 weeks. Thereafter glibenclamide or placebo was added to insulin for a further 12 weeks. Glibenclamide improved the glycemic control as expressed by a diminution of blood glucose and HbA_1c. This was observed in spite of the fact that the daily insulin dose was reduced by approximately 30% in the glibenclamide-treated group of patients. It is concluded that in NIDDM patients with second failure to glibenclamide ot glipizide therapy, the responsiveness to glibenclamide may be at least partially restored by a short period of insulin treatment. It is suggested that therapy with insulin and glibenclamide is an appropriate treatment regimen for NIDDM patients with second failure to sulfonylurea therapy.     

Solid-phase synthesis of trypsin inhibitor CMTI III from squash seeds (Cucurbita maxima)*

Using the solid-phase procedure, a linear 29-peptide with the reported sequence of trypsin inhibitor CMTI III was synthesized and oxidized to give three disulphide bridges. After affinity chromatography on an immobilized anhydrotrypsin column the synthetic product was shown by various physical techniques to be identical with the trypsin inhibitor CMTI III from squash seeds (Cucurbita maxima).     

Once Daily Dosing of Enalapril in Congestive Heart Failure

Enalapril 40 mg or tolerated dose was given once daily to 21 patients with congestive heart failure (CHF), NYHA class III, in addition to treatment with digoxin and/or diuretics. After an 8-week open period, 19 patients were randomized to continue enalapril or to receive a placebo in a double-blind manner. After the first enalapril dose of 10 mg, maximal reduction of blood pressure (BP) occurred after 4 hours (mean 34/17 mmHg; p<0.001). No further reduction was found after higher doses. After the open period significant improvement was shown as judged by NYHA class (p<0.01), stroke volume (p<0.05), maximal working capacity (p<0.05), heart volume (p<0.01) and maximum rate pressure product (RPPmax) (p<0.001). Urinary aldosterone markedly decreased (p<0.01), whereas serum potassium and serum creatinine slightly increased (p<0.05). At the end of the blind period enalapril was superior to placebo concerning NYHA class (p<0.01), heart volume (p<0.05) and RPPmax (p<0.05). Other parameters, including aldosterone in urine, did not differ between the groups. Carry-over effects may have diminished the differences between enalapril and placebo. Diarrhoea (n=5) and hypotension (n=5) were the most common side-effects. Overall, enalapril was well tolerated and seems to be useful in single daily doses in the treatment of CHF.