Effect of anticoagulation upon nephron obstruction in experimental acute ischaemic renal failure. A morphological study

Ischaemic-reperfusion injury as a model of acute renal failure (ARF) results in increased macromolecular permeability, tubular obstruction, and renal oedema. To investigate the role for coagulation in this model, anticoagulated and saline-pretreated rats were subjected to 60 min unilateral renal artery occlusion (RAO). After 15 min of reflow, specimens were collected for electron and light microscopic examination. Morphometry was employed to study podocyte changes and Bowman's space dilatation as measures of increased permeability and tubular obstruction, respectively. After 15 min of reflow, Bowman's space increased significantly and the podocytes were markedly widened and flattened. Rats pretreated with heparin or warfarin showed less widening of Bowman's space than saline-treated rats, whereas no significant difference was seen regarding the podocyte changes. In saline-treated rats, fibrin-positive material was seen in the tubules but not in the urine sediments collected after 90 min of reflow, either due to fibrinolysis or poor urinary elimination. The results suggest that anticoagulation does not preclude the glomerular sieving of macromolecules, but seems to reduce tubular obstruction, probably by preventing conversion of filtered fibrinogen into fibrin.     

Long-Term Follow-Up of Patients Treated with Automatic Scanning Antitachycardia Pacemaker

The long-term efficacy of an automatic antitachycardia pacemaker was evaluated in 13 patients with supraventricular tachycardia and in two patients with ventricular tachycardia. Patients were followed for 4–53 months (median 16). The concertina scanning mode with 2–7 extrastimuli proved to be effective in all patients but one. During follow-up, two patients had to be reoperated due to sensing problems. Atrial flutter was induced during scanning in one patient, termination mode was triggered by sinus tachycardia in one patient despite beta blocker therapy, and in one patient after cessation of beta blocker treatment. The pacemaker did not induce any serious arrhythmias and no sudden deaths occurred. Seven patients were given beta blockers, one patient with ventricular tachycardia was additionally administered amiodarone. In conclusion, the PASAR 4171 (Telectronics, Englewood, CO, USA) automatic scanning pacemaker is an alternative or adjunctive means to chronic antiarrhythmic drug therapy in patients with supraventricular tachycardia, but further versatility with regard to sensitivity, refractory period, and tachycardia recognition is required to eliminate the shortcomings observed, including the need for additional beta blocker therapy.     

Faecal Concentrations and Production Rates of Short Chain Fatty Acids in Normal Neonates

ABSTRACT. Changes in intestinal microbial flora are reflected in the faecal concentrations and production rates of short chain fatty acids. However, since no data on the latter are available in neonates, the aim of this study is to provide information on short chain fatty acids in faeces from normal neonates. Faecal samples were collected immediately after birth (meconium) and on the 4th day of life in 13 healthy, full-term neonates. The production capacity was evaluated by a faecal incubation system. Concentrations of short chain fatty acids were low in meconium (11.2+3.9 mmol/l (mean±SD)), equivalent to about 10% of the adult level ( p <0.01), but increased significantly during the first 4 days of life to 28.4±20.1 mmol/l ( p <0.05). The fermentation pattern (i.e. relative composition of different acids) showed differences between adults and neonates, primarily due to a higher proportion of acetate found in the latter. The ratio acetate/propionate/butyrate/other acids was 89/5/5/1 in 4-day-old neonates compared to 65/18/11/6 in adults ( p <0.001). Our findings correlate well with the postnatal microbial colonization of neonatal colon.     

Effect and stage models in community intervention programmes; and the development of the Model for Management of Intervention Programme Preparation (MMIPP)

Recent years have seen the development of a number of diagrammatic‘models’ bearing on community intervention programmes.There have been two basic types, one involving actual or hypotheticalcausal relationships (effect, or how-it-works models) and theother, sequences of activities or events (stage, or how-to-do-itmodels). A selection of such models, with their roots in differenttheories of social change, health education and health promotion,are reviewed in the light of this distinction. Both types ofmodel are important. Existing stage models for health promotion programmes implyan ordered or cyclical set of activities, in which preparationis followed by implementation, maintenance, evaluation and revision.In the second part of the paper a new and more detailed typeof stage model is presented for the preparatory phase. In practice,this phase involves a series of parallel but interdependentactivity streams. These add up to a complex process that needsto be carefully planned and managed. In such circumstances itis important to be able to convey to the various people andorganisations involved how their different contributions meshtogether. The new model is designed to help with this. It hasbeen developed in the light of experience of planning community-baseddisease prevention programmes in Stockholm and elsewhere, withthe objective of making the lessons learned available for othersin a compact and accessible form.     

GLUCOCORTICOID MAINTENANCE THERAPY FOLLOWING ADRENALECTOMY: ASSESSMENT OF DOSAGE AND PREPARATION

Plasma cortisol was monitored repeatedly after oral administration of cortisol and cortisone (cortisone acetate) to seven adrenalectomized patients with pituitary-dependent Cushing's syndrome. The amount of glucocorticoid administered was 25 mg cortisol or 33 mg cortisone/g urine creatinine/24 h. Peak plasma cortisol levels were within recommended values in all patients after cortisone and in three of the patients after cortisol. The remaining four patients had elevated peak plasma cortisol levels after cortisol. Transcortin binding capacity in plasma was normal. It is concluded that cortisol as well as cortisone is suitable for oral glucocorticoid substitution therapy in patients with normal liver function, but that cortisone apparently gives a marginally smoother plasma cortisol curve. However, it is essential to monitor plasma cortisol after institution of glucocorticoid maintenance therapy, since different and unpredictable plasma cortisol levels may exist after a given amount of glucocorticoid, although the dose required correlates reasonably well with creatinine excretion in urine.     

Defective neutrophil motility in patients with primary ciliary dyskinesia

Microtubules are important in the regulation of the motile functions of a variety of cells, including leukocytes, ciliated cells and spermatozoa. Polymorphonuclear leukocyte function was studied in ten patients with primary ciliary dyskinesia, an inherited disorder of microtubules in sperm tails and cilia. Neutrophil chemotaxis in Boyden chambers was slightly reduced, but only one patient showed a migration below normal values. In vivo mobilization of polymorphonuclear leukocytes into skin windows was also slightly decreased. In contrast, neutrophil polarization and orientation was normal. The bactericidal activity of neutrophils from patients with primary ciliary dyskinesia was normal, while the ingestion of bacteria was decreased. The abnormalities of neutrophil function in patients with primary ciliary dyskinesia are related to motility. It is suggested that the microtubule defect responsible for the abnormal pattern of ciliary beating is a general abnormality also responsible for the depression of polymorphonuclear leukocyte motility.     

Hyperplasia,keratosis, dysplasia and carcinoma in situ of the vocal cords—a follow-up study

Comparison of reported series of laryngeal lesions is complicated by the inconsistency in the terminology. The classification of these lesions should logically be based on the degree of dysplasia, as this has a bearing on the prognosis. The material for this study consisted of 193 patients with hyperplasia and/or keratosis, with or without mild dysplasia (Group I), moderate dysplasia (Group II), and severe dysplasia and carcinoma in situ (Group III). They were treated over a 14-year period (1966–1979) at Linköping University Hospital. Of the 98 patients in Group I available for follow-up, 23 had repeat excisions. Moderate dysplasia developed in 3 patients, severe dysplasia in 2, and invasive carcinoma in another 2 within 3 and 3.5 years; they both underwent laryngectomy. Among the 24 patients in Group II available for follow-up, severe dysplasia developed in 3 and invasive carcinoma in 3 up to 13 years after the initial diagnosis, all but one (with severe dysplasia) received a full course of radiotherapy, in one case total laryngectomy was subsequently performed for recurrent carcinoma. Of the 39 patients with severe dysplasia and carcinoma in situ 16 were given primary radiotherapy; 4 of these developed invasive carcinoma; 3 of them underwent total laryngectomy and one partial laryngectomy. Excision or stripping of the vocal cords was the primary treatment in 23 cases; 5 of these developed invasive carcinoma; 2 of them underwent total laryngectomy. Diffuse lesions and well differentiated forms of severe dysplasia caused most problems and had the highest incidence of invasive carcinoma irrespective of the form of treatment. Patients with hyperplasia, keratosis, dysplasia and carcinoma in situ should be carefully followed up, as invasive carcinoma may develop many years after the initial diagnosis.     

VASOACTIVE INTESTINAL POLYPEPTIDE (VIP) IN CHILDREN WITH NEURAL CREST TUMOURS

ABSTRACT. The concentration of vasoactive intestinal polypeptide (VIP) in plasma was measured in 22 children with neural crest tumours (NCT) during a 5-year period; the mean concentration of VIP in plasma was 22.5 pmol/l (interval 2.0-95.0 pmol/l). To establish a reference interval the plasma concentration of VIP was measured in 41 children without tumours; the mean concentration of VIP in plasma was 6.2 pmol/l (interval 0.5-19.0 pmol/l). Of the 22 children with NCT 16 had a plasma concentration of VIP within the normal range while 6 children (27%) had elevated plasma concentration of VIP between 28 and 95 pmol/l. Only one child, whose plasma concentration of VIP was 95 pmol/l had diarrhoea. Elevated plasma concentration of VIP in children with NCT but no diarrhoea has not previously been described. The urinary excretion of vanillylmandelic acid (VMA) was increased in 18 of the children with NCT (82%). In 2 of the children with normal excretion of VMA the concentration of VIP in plasma was elevated. Thus, the plasma concentration of VIP may be a supplement to VMA as a tumour marker in some cases of NCT.     

Initiation of Spermatogenesis during Chemotherapy for Leukemia

ABSTRACT. Although the information is sparse, cytotoxic drugs have been suspected to cause serious damage to the immature testis, especially when the treatment is given during puberty. In a prospective, longitudinal study, we have investigated the effect of combination chemotherapy on the maturation of the germinative epithelium in 22 testicular biopsy specimens from 10 pubertal boys with acute lymphoblastic leukemia. Five of the boys developed complete spermatogenesis including spermatozoa during the treatment, the biopsy specimens of two patients showed partial maturation of the seminiferous epithelium, while the germ cells of two boys remained immature. In one patient, who received large doses of cyclophosphamide and cytosine arabinoside, all germ cells disappeared during the therapy. We conclude that a significant proportion of boys with acute lymphoblastic leukemia may develop potential fertility even while on treatment with cytotoxic drugs during puberty.     

On the mode of action of the sympathetic fibres on intestinal fluid transport: Evidence for the existence of a glucose-stimulated secretory nervous pathway in the intestinal wall

The effect of sympathetic nerve stimulation or close i. a.infusion of noradrenaline on net fluid transport was investigated on anesthetized cats. In the presence of glucose in the solution perfusing the intestinal lumen the adrenergic mechanisms increased net fluid absorption in normal intestines. Substituting glucose with mannitol in the perfusate abolished this effect of adrenergic stimulation on the net fluid uptake. Furthermore, the effect of noradrenaline on net fluid transport in normal or choleraic intestines was abolished by tetrodotoxin (TTX), a nerve conductivity blocking agent. This suggests that the sympathetic influence is dependent on intraluminal glucose and that noradrenaline exerts its effect mainly via nerves. TTX significantly increased fluid uptake from normal intestines perfused with an isotonic electrolyte solution containing glucose while a considerably smaller effect was seen in intestinal segments perfused with a solution with mannitol. Based on these findings it is proposed that glucose in some way activates intramural nervous reflex(es) in the intestinal wall. According to this hypothesis the enhancement of fluid transport induced by adrenergic stimuli is explained by an inhibition of the glucose-activated nervous secretion