Calciumantagonisten: Antihypertensiva der ersten Wahl

Ein 57-jähriger Bankangestellter stellt sich wegen seit Monaten bestehender Abgeschlagenheit und Müdigkeit vor. Anamnese: seit 3 Jahren dokumentierte Hypercholesterinämie (Gesamtcholesterin 350 mg/dl) und Hypertriglyzeridämie (Triglyzeride 430 mg/dl), zurzeit mit einem Statin behandelt, ferner seit einem 1/2 Jahr symptomatische Gicht (letzter Anfall vor 4 Wochen), jetzt mit 300 mg Allopurinol behandelt, sowie Claudicatio intermittens (Gehstrecke 300 m) bekannt. Seit der Jugend ist zudem ein allergisches Asthma bekannt, das mit inhalativen Steroiden und einem lang wirkenden β-Mimetikum behandelt wird. Die Frage nach Dyspnoe, Thoraxschmerzen oder einer plötzlich auftretenden Hautblässe wird verneint.Körperliche Untersuchung: Gewicht 89,2 kg, Größe 1,78 m, Blutdruck 210/90 mmHg. Die 24-h-Blutdruckmessung zeigt eine nächtliche Blutdrucksenkung von 15% systolisch und 12% diastolisch. In der Routinelaboruntersuchung keine Auffälligkeiten, insbesondere ausgeglichene Elektrolyte, normale Nierenfunktion. Im Urin-Stix keine Erythrozyt- oder Proteinurie. Verlauf: Der Patient erhält zunächst 5 mg Amlodipin und wird bezüglich nichtmedikamentöser Maßnahmen eingehend beraten. Bei einer Wiedervorstellung nach 3 Wochen hat er 1,5 kg an Gewicht abgenommen und einen Blutdruck von 170/85 mmHg.     

A randomized clinical trial with a 0.6% amino acid/ 1.4% glycerol peritoneal dialysis solution.

BACKGROUND: Glucose is an accepted osmotic agent for peritoneal dialysis (PD) although it has several drawbacks. Some of these drawbacks have been addressed by the introduction of solutions with low glucose degradation products and physiological pH in dual-chambered bags. Despite this achievement, there is a need for alternative osmotic agents.This randomized clinical trial analyzes 3-month's clinical experience with a mixture of 0.6% amino acids and 1.4% glycerol. METHODS: The study was performed at the renal units of the University Hospitals Ghent, Belgium, and Utrecht, The Netherlands. Stable PD patients were randomized for either protocol A (test solution, n = 5) or protocol B (control regimen, n = 5). In both protocols, there was a run-in phase of 1 month with a dialysis regimen of 2 x 2 L 2.27% glucose solution (Dianeal; Baxter, Nivelles, Belgium), 1 x 2 L Extraneal (Baxter), and 1 x 2 L glucose solution (Dianeal). After this month-long run-in period, patients in group A received during 3 months 2 x 2 L amino acid/glycerol solution, 1 x 2 L Extraneal, and at least 1 x 2 L of a classic glucose solution. RESULTS: Glucose absorption decreased in the test group during the test phase (from 84.2 +/- 8.7 to 11.7 +/- 11.6 g/24 hours, p = 0.001). Dialysate levels of cancer antigen 125 (CA125) increased in the test group, from 17.5 +/- 11.0 to 32.4 +/- 4.6 units/L (p = 0.04), whereas, in the control group, the levels remained stable (15.5 +/- 8.7 and 14.9 +/- 9.8 units/L respectively, p = 0.4).There were no differences in serum urea, serum bicarbonate, serum osmolarity, serum albumin, or parameters related to skin-fold thickness or serum glycerol levels between control and test solutions. No differences were observed in obtained ultrafiltration after a 4-hour dwell with 2.27% glucose or the test solution, both measured at week 4 of the run-in period and week 12 of the test period. CONCLUSION: This study demonstrated that the use of a new 0.6% amino acid/1.4% glycerol-containing dialysis solution is safe and well tolerated. Glucose load was reduced significantly and dialysate CA125 levels improved significantly. Ultrafiltration was comparable with that of a 2.27% glucose solution. All these factors, in combination with the potential nutritional benefits, can contribute to a beneficial impact on the success of the PD technique. Further long-term studies in larger patient groups are warranted to explore the potential of this promising new solution.     

Nonablative Phototherapy for Acne Vulgaris Using the KTP 532 nm Laser

BACKGROUND: Acne vulgaris is an acute inflammatory disease of the pilosebaceous units. The bastion of treatment for acne vulgaris has been the use of topical and systemic therapies. Despite many modalities available for treatment, there exists an imperative need for effective noninvasive treatments that reduce the risks of medication side effects. OBJECTIVE: To study the safety and efficacy of the potassium titanyl phosphate (KTP) 532 nm pulsed laser for the treatment of acne vulgaris. METHODS: Twenty-six subjects, clinically evaluated with moderate facial acne, were enrolled in this single-center prospective trial. The entire facial area for each subject was divided in half and randomly designated as either a treatment or a control side. Each subject was treated with four laser exposures using a KTP 532 nm laser with continuous contact cooling. The results were assessed at 1 and 4 weeks post-final treatment. Primary outcome measures were Micha?lsson acne severity score and adverse treatment effects. Secondary outcome measures included subjective evaluations from the investigator and patients assessing their overall percent satisfaction. RESULTS: Primary outcome analysis in the Micha?lsson acne severity score demonstrated a mean 34.9% (p = .011) and 20.7% (p = .25) reduction at the 1-week and 4-week post-final treatments, respectively. Subjective investigator evaluations of overall percent satisfaction indicated that all patients demonstrated a minimum 50% overall satisfaction in treatment outcomes at the 4-week follow-up period. No side effects were encountered. CONCLUSION: Use of the KTP 532 nm laser for the treatment and management of acne vulgaris is both safe and effective, with positive results enduring up to 4 weeks post-treatment.     

Avulsion of the distal tendon of the biceps brachii

1.

1. Avulsion of the distal tendon of the biceps brachii is a rare injury.     

Minimal Acute Rejection after Lung Transplantation: A Risk for Bronchiolitis Obliterans Syndrome

Bronchiolitis obliterans syndrome (BOS) is a major cause of lung allograft dysfunction. Although previous studies have identified mild to severe rejection (grade>or=A2) as a risk factor for BOS, the role of minimal rejection (grade A1) remains unclear. To determine if A1 rejection by itself is a risk factor for BOS, we performed a retrospective cohort study on 228 adult lung transplant recipients over a 7-year period. Cohorts were defined by their most severe rejection episode (none, A1 only, and >or=A2) and analyzed for the subsequent development and progression of BOS using univariate and multivariate time-dependent Cox regression analysis. In the univariate model, the occurrence of isolated minimal rejection was a risk factor for all stages of BOS. Similarly, multivariate models that included HLA mismatch, cytomegalovirus pneumonitis, community acquired viral infection, underlying disease and type of transplant demonstrated that A1 rejection was a distinct risk factor for BOS. Furthermore, the associated risk with A1 rejection was slightly greater than the risk from >or=A2 and treatment of A1 rejection decreased the risk for subsequent BOS stage 1. We conclude that minimal rejection is associated with an increased risk for BOS development and progression that is comparable to A2 rejection.     

A new CD43 monoclonal antibody induces homotypic aggregation of human leucocytes through a CD11a/CD18-dependent and -independent mechanism.

We describe a monoclonal antibody (mAb), designated 1.C1, that causes rapid and vigorous aggregation among normal leucocytes and among T and myeloid/monocytic cell lines. As shown by competitive binding and sequential immunoprecipitation experiments, the antigen recognized by mAb 1.C1 is a 115,000 MW sialoglycoprotein, that corresponds to the human CD43 antigen, also known as leukosialin or sialophorin. The aggregation process starts within minutes and reaches maximum level 6-18 hr after addition of the antibody. It is dependent on active cell metabolism (inhibited at low temperatures and by a mixture of the metabolic poisons azide and 2-deoxy-D-glucose), a fluid plasma membrane (inhibited by pretreatment of the cells with paraformaldehyde) and an intact cytoskeleton (inhibited by cytochalasin B). Two reference CD43 antibodies (MEM-59 and DF-T1), both binding the same or closely related sialic acid-dependent epitope as mAb 1.C1, are also capable of inducing cell clump formation. CD11a/CD18 mAb block the 1.C1-induced adhesion of resting peripheral blood leucocytes, but not of haematopoietic cell line cells. In addition, mAb 1.C1 induces homotypic aggregation of K-562 cells, which do not express members of the beta 2 integrin subfamily on their surface. These data suggest that triggering of the CD43 antigen promotes homotypic cell adhesion that is mediated by both CD11a/CD18-dependent and -independent pathways.     

Subfractionation of human T lymphocyte subpopulations by partitioning: surface heterogeneity of the OKT8/Leu2+ T cell subset.

Human peripheral blood mononuclear cells (PBMC) were subjected to countercurrent distribution in a charge-sensitive dextran-poly (ethylene glycol) aqueous two-phase system. Cells are thereby subfractionated on the basis of their charge-associated surface properties. The helper/inducer T cell subset (OKT4/Leu3+) has a single distribution curve with a low partition ratio (P). In contrast, the suppressor/cytotoxic (OKT8/Leu2+) subset is clearly heterogeneous and gives two peaks, one with a lower and the other with a higher P value. The cells in the latter peak constitute part of a minor subpopulation of cells enriched with natural killer (Leu7+) cells. Double labelling studies indicate that a majority of Leu2+ cells with a high P value also have a marker of natural killer cells (HNK-1), whereas the Leu2+ cells with low partition ratio are depleted with respect to cells bearing both markers.