Long-term effects of treatment with recombinant human erythropoietin on haemodynamics and tissue oxygenation in patients with renal anaemia

Regional peripheral vascular resistance, transcutaneous oxygen pressure and blood pressure were studied in seven normotensive, chronically haemodialysed patients with renal anaemia before and after 3 and 12 months of rHuEpo therapy. Haematocrit increased from 21% to 33% within 3 months of commencing therapy, and remained stable throughout the following observation time. Though regional blood flow of the calf was markedly reduced after 3 and 12 months of rHuEpo compared to pretreatment values, transcutaneous oxygen pressure was significantly increased after 3 months and remained constantly elevated after 12 months. Mean arterial blood pressure increased significantly by 7.3 mmHg after 3 months of rHuEpo treatment but did not reach hypertensive values and was no longer different from pretreatment values 12 months after the start of rHuEpo. Results of peripheral haemodynamic studies were compared to those obtained by measurement of central haemodynamics in four further normotensive anaemic patients. In these patients cardiac output decreased, total peripheral vascular resistance increased and blood pressure increased slightly (by 5.5 mmHg) when a haematocrit of 37% was reached after 8 weeks of rHuEpo therapy. These effects were partly reversed when the maintenance haematocrit decreased to 32% (after 16 weeks of rHuEpo). In summary rHuEpo treatment induced a long-term increase of the total and regional peripheral resistance, an increase of blood pressure within the normal range, and a decrease in cardiac output. Despite these changes tissue oxygenation improved.     

Congenital epulis.

Congenital epulis of the newborn is a rare gingival tumor that occurs along the alveolar ridge. We report the prenatal sonographic and postnatal MR imaging findings in an infant with maxillary and mandibular congenital epulides.     

Microalbuminuria in children and adolescents with and without Type-I diabetes mellitus (IDDM)

In 73 healthy (group I) and 32 children and juveniles with insulin dependent diabetes mellitus (IDDM, group II) urinary albumin excretion is determined by radioimmunoassay (RIA). In both groups albumin excretion is observed in every urine sample when measured by RIA (mean +/- SD: group I: 7-19 h: 5.17 +/- 5.28 mg, 19-7 h: 3.86 +/- 4.00 mg, 24 h: 9.03 +/- 8.60 mg; group II: 7-19 h: 6.68 +/- 6.86 mg, 19-7 h: 3.46 +/- 2.82 mg, 24 h: 10.13 +/- 9.25 mg). No significant difference is detected between the values of the two groups. However in diabetic patients a significant difference is observed between diurnal and nocturnal urinary albumin excretion. Microalbuminuria is defined as an albumin excretion above 30 mg/d and is present in 6.9% of the values in group I and in 3.1% in group II. The physiological limits of microalbuminuria in children and juveniles compared to adults and several methods of urine sampling are discussed.     

Importance of thiols in the reductive binding of 2-nitroimidazoles to macromolecules

Reductive activation of 2-nitroimidazoles in the presence of bovine serum albumin (BSA) led to binding of the nitroheterocycles to the protein. The binding was most efficient to BSA in which protein disulfides had been reduced to thiol groups. Protein thiols were at least twenty times more efficient than other protein, RNA or DNA nucleophiles in binding the reductively-activated nitroheterocycles. This result is of practical importance in the development of immunoassays for 2-nitroimidazoles as hypoxia markers in normal and tumor tissue.     

Candida albicans infection of a prosthetic knee replacement: a report and review of the literature

A woman with rheumatoid arthritis who underwent total knee arthroplasty is described. The implant became infected with Staphylococcus epidermidis and she received a prolonged course of postoperative antistaphylococcal antibiotics. Four months postoperatively she developed a calf ulcer that grew Pseudomonas aeruginosa and required further antibiotic therapy. One year later she presented with a painful, swollen knee with radiographic findings suggesting loosening of the prosthetic knee implant. Arthrocentesis cultures grew Candida albicans. She was treated with arthrodesis, amphotericin B, 5-fluorocytosine, and ketoconazole and remains free of infection 21 months after removal of the prosthesis. The clinical course of 6 other cases of Candida prosthetic joint infections is reviewed.     

Identification of N2 as a metabolite of acetylhydrazine in the rat

 In the pathogenesis of isoniazid-induced hepatic injury, cytochrome P450-dependent metabolic activation of the metabolite, acetylhydrazine (AcHz), is the crucial step. Exhalation of [¹⁴C]-carbon dioxide has previously been used to quantify indirectly this pathway. In contrast, according to the current concept of AcHz bioactivation, molecular nitrogen is produced directly, but has not yet been identified. Here, we measured [¹⁵N]-nitrogen and ¹⁴CO₂ exhalation, after the administration of [¹⁵N₂]-[¹⁴C]-AcHz, in rats. Laser magnetic resonance (LMR) spectroscopy, a new sensitive and specific technique for the measurement of ¹⁵N and ¹⁴N in gas samples, was used. To demonstrate the involvement of cytochrome P450, rats were treated with phenobarbital (PB) or PB + cobalt(II) chloride (CoCl₂) (n=3 in each group). Time-dependent ¹⁵N₂ exhalation differed significantly between treatment groups (p<0.001). At 240 min, cumulative exhalation of ¹⁵N was 1.92±0.43% (mean±SE) of the dose in the control group, 2.53±0.23% in the PB group, and 1.00±0.15% in the PB+CoCl₂ group (p<0.05 compared to controls, p<0.01 compared to PB). Cumulative exhalation of ¹⁴CO₂ in 24 h ranged from 15.1 to 21.9%, with no significant difference between treatment groups. In conclusion, N₂ is a metabolite of AcHz. N₂ formation reflects the cytochrome P450-mediated activation of AcHz and can be used as an index of this pathway. Generally, LMR spectroscopy is valuable for monitoring any N₂-liberating process in vivo. Received: 14 March 1995/Accepted: 15 August 1995     

Effects of acetylsalicylic acid on electromechanical activity ofin vivo rabbit ileum

Aspirin has antisecretory and ulcerogenic properties in the gastrointestinal tract. The aim of this study was to determine the effects of acetylsalicylic acid (ASA) on the electrical and mechanical activity of the ileum in anesthetized New Zealand White rabbits. Ileal electromechanical activity was recorded from serosal electrodes and a miniature intraluminal balloon. Thirty minutes after injection of ASA (30, 60 and 100 mg/kg intravenous) significant and dose-dependent increases in the percentage of slow waves with action potentials were observed when compared with saline-injected animals. The onset of action potentials correlated with phasic increases in intraluminal pressure, indicating the onset of circular muscle contractions. Injection of 15 mg/kg ASA, sodium salicylate (100 mg/kg intravenous) or saline had no effect on baseline action potential activity. Prostaglandin E ₂ (PGE ₂)(5 and 10 g/kg intravenous) significantly increased slow-wave frequency and decreased ASA-induced action potential activity. This study demonstrates that (1) ASA, but not sodium salicylate, stimulates phasic ileal action potential and contractile activity and (2) in ASA-treated animals, PGE ₂ produces differential effects on in vivoslow-wave frequency and action potential activity.     

The zurich study

Summary This study describes sleep behaviour and insomnia in a representative cohort of a Swiss population. Interviews were carried out prospectively from age 20–21 to 27–28 years, starting with 292 males and 299 females. Females usually go to bed earlier and sleep 30 min longer than males. Taking into account length and periodicity of insomnia we can distinguish occasional insomnia (OI), repeated brief insomnia (RBI), and continued insomnia (CI), defined by operational criteria. The prevalence of sleep problems is stable from age 21–28, at 36%–40%. CI (prevalence 8%–10%) and RBI (13%–19%) are both medical problems in terms of treatment by professionals (10%–17%) or self-medication (7%–12%). The majority of insomniacs cope with sleep problems in various other ways. Frequency and patterns of symptoms of insomnia are described.The authors thank P. J. Clayton, M.D., University of Minnesota, Minneapolis, for advice and critical suggestions and for the coining of the terms repeated brief insomnia and continued insomnia.Project supported by grant 3.948.0.85 from the Swiss National Science Foundation.Parts of this article were presented on the occasion of the inauguration ceremony of the Department of Psychiatry of the University of Mainz on April 2 and 3, 1987     

Iridoids from Scaevola racemigera1

Five iridoids have been isolated from the aerial parts of SCAEVOLA RACEMIGERA D?niker, namely, loganin, loganic acid, sylvestroside III, cantleyoside, and scaevoloside. This latter is a novel compound whose structure 1 has been elucidated on the basis of its spectral data, mainly (1)H- and (13)C-NMR.     

The immunofluorescence-microscopical evidence of insulin and glucagon in transplantated isolated Langerhans' islets in diabetic rats and dogs (author's transl)]

With the histochemical immunofluorescence technique were demonstrated the insulin and glucagon in the transplantated isolated Langerhans' islets in the liver at diabetic rats and dogs. Further on were tested the diabetic metabolic level with aid of clinico-chemical methods during the period of investigation (blood glucose, serum insulin, glucose tolerance test). It was found that after transplantation, 1 year by the rats and more than 8 weeks by the dogs, is existing a normoglycemic level. In the transplanted islets were seen a good immunofluorescence of insulin in the B cells and the glucagon in the A cells in all investigated stages.