Tubular absorption of filtered cystatin-C in the rat kidney

As shown in previous studies, the two basic proteins aprotinin (Ap, 6.5 kDa) and cystatin (Cy, 13.3 kDa) can be used to estimate whole kidney glomerular filtration rate by measuring the renal cortical uptake relative to plasma concentration after i.v. injection. Local uptake of Ap can also be used to estimate local filtration rate, and the present experiments were undertaken to examine whether Cy would give a similar uptake pattern. Ap and Cy were labelled with 131I and 125I, respectively, and injected as an i.v. bolus. Frequent blood samples provided information on the filtered load. Five to 20 min after injection the kidney was clamped, frozen, and five tissue samples of 5-10 mg each were cut out from outer (OC), middle (MC) and inner cortex (IC) to be weighed and assessed for radioactivity. Five minute clearance ratios, Cy:Ap, were 1.36 +/- 0.04, 1.27 +/- 0.03 and 1.19 +/- 0.04 in OC, MC and IC, respectively. The higher Cy clearance was expected from a higher glomerular filtrate:plasma ratio of the less basic Cy (Donnan distribution). However, this does not explain the increase of Cy:Ap clearances going from IC to the OC. A surplus of extracellular uptake of Cy in superficial layers was excluded, leading to the following interpretation. In all cortical layers the proximal convoluted tubule, i.e. the protein uptake segment, is located more superficially than its parent glomerulus. A longer uptake segment for Cy than for Ap will therefore lead to a relative greater transfer of filtered Cy from IC to MC, and from MC to OC. Anatomical studies on single nephrons presented in another article lend strong support to this interpretation.     

Skin Sensitization in School Children in Northern and Southern Norway

It has been suggested that environmental exposures and living conditions can explain some of the worldwide variation in atopic disorders. Norway has large environmental contrasts within the country. We compared skin prick sensitization rates among school children living in the southern subarctic and in the northern artic part of Norway. Approximately one quarter of the children were sensitized, mostly against pollen and animal dander, while mite and mould sensitization seemed to be a minor problem. Sensitization rates and profiles were similar in the north and south despite differences in living conditions and environmental exposures.     

Medical decision making for older patients during multidisciplinary oncology team meetings

Objectives

Multidisciplinary team meetings aim to facilitate efficient and accurate communication surrounding the complex process of treatment decision making for older patients with cancer. This process is even more complicated for older (≥70?years) patients as the lack of empirical evidence on treatment regimens in patients with age-related problems such as comorbidity and polypharmacy, necessitates a patient-centred approach.This study investigates the decision making process for older patients with cancer during multidisciplinary team meetings and the extent to which geriatric evaluation and geriatric expertise contribute to this process.

Fatigue in patients with systemic lupus erythematosus: the psychosocial aspects

OBJECTIVE: Studies to prove a relationship between fatigue and immunological, inflammatory, or other disease characteristics of systemic lupus erythematosus (SLE) have shown no consistent findings. To further elucidate the basis for fatigue in SLE, we examined the affective states, personality traits, and mental health status in an unselected group of patients with SLE. METHODS: Fifty-seven Caucasian patients with SLE were examined. Fatigue was measured by the Fatigue Severity Scale. Personality traits and psychological function were evaluated by the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), the affective states by Beck Depression Inventory, and mental health status by the General Health Questionnaire version 30 (GHQ-30). RESULTS: Fatigue was closely associated with high scores on subscales Depression (D-2) and Hysteria (Hy-3) on MMPI-2 (R2 = 0.31; p = 0.0002), as well as with high scores on BDI (R2 = 0.22; p = 0.0006) and GHQ (R2 = 0.33; p < 0.0001). CONCLUSION: Fatigue does not seem to be caused by any easily recognizable single or multiple factor(s) of an inflammatory or immunological state. Our results point to fatigue being a multifaceted phenomenon where several psychosocial factors are strongly related, and indicate that fatigue is part of a complex response to chronic disease.     

Wegener's granulomatosis of the prostate gland

Wegener's granulomatosis (WG) is a systemic granulomatous vasculitis affecting medium and small arteries, venules, and arterioles. The upper and lower respiratory tract and kidney are primarily involved. Patients with classic WG essentially present with upper airway and pulmonary involvement. Renal disease is common. Involvement of other organ systems is also relatively frequent, most often heart, joints, muscles, eyes, skin, and central and/or peripheral nervous system. We present a patient in whom WG was diagnosed primarily because of prostate involvement. This seems to be a rare manifestation.     

Book Review

ORIGINS OF LYMPHOCYTE DIVERSITY Cold Spring Harbor Symposia on Quantitative Biology Volume XLI, Cold Spring Harbor Laboratory, 1977 hardbound; 2 volumes, 902 pages; $60.00

IMMUNOCHEMISTRY OF PROTEINS M.Z. Atassi, Ed. Plenum Press, New York, 1977; hardbound, Vol. 1, 485 pages, $44.50; Vol. 2, 438 pages, $44.50

IMMUNOLOGIC ASPECTS OF THE LIVER AND THE GASTROINTESTINAL TRACT A. Furguson and R.N.M. MacSween, Eds. University Park Press, Baltimore, 1976 404 pages, hardbound, $19.50

Contemporary Topics in Immunobiology Vol. 6 Immunobiology of oncogenic viruses M.G. Hanna, Jr. and F. Rapp, eds., hardbound, 289 pp.; (Plenum Press, New York); $33.00; 1977

HOSPITAL ACQUIRED INFECTIONS IN SURGERY H.C. Polk, Jr. and H.H. Stone, Editors University Park Press, Baltimore, London, Tokyo, 1977: Hardbound, 158 pages, $16.50

HUMAN HEALTH AND DISEASE P.L. Altman and D.D. Katz, Eds. Federation of American Societies for Experimental Biology, Bethesda, Maryland, 1977; hardbound, 435 pages, $45.00.

MECHANISMS OF TUMOR IMMUNITY Edited by Ira Green, Stanley Cohen and Robert T. McCluskey:hardbound; 320 pp (John Wiley &; Sons, New York - London - Sydney - Toronto) $19.80

MEDICAL IMMUNOLOGY M.S. Thaler, R.D. Klausner, H.J. Cohen J.B. Lippincott Co., Philadelphia, Toronto, 1977; hardbound; 480 pages; $17.00     

Presence of IgG-CD4 Complexes in the Circulation

Many proteins of various origins are able to form complexes with Immunoglobulin G using reaction sites formed by residues of constant domains. Studies of IgG complexes of non-immune nature are important as biologically active proteins could escape from the circulation forming complexes with IgG as well as with other serum proteins whose concentration in serum is high. A quantitative characterization of circulating complexes in various diseases could give valuable information on the development of pathological processes. Immunoglobulins G are widely used for the treatment of a number of diseases and it is essential to understand what proteins are present in the preparations beside IgG. In the present study CD4 T-cell membrane glycoprotein was found in complexes with human IgG molecules isolated from donor sera as well as from sera of SLE patients via a sensitive quantitative dot-blot assay. According to immunoblotting experiments the CD4 part of the complexes had a molecular mass of about 50 kDa and is composed from all four extracellular domains. The CD4 content of the complexes varied among the studied human sera. There was no difference in IgG-CD4 complex concentration between the SLE patients and healthy controls. The data support the assumption that IgG molecules are able to act as scavengers and eliminate various proteins from the circulation including soluble CD4 protein.     

Development of sarcoidosis following etanercept treatment: a report of three cases

After over 10 years of use of tumor necrosis factor-alpha (TNF-α) inhibitors, their side effects and complications are reasonably well documented. Recently, however, granulomatous reactions and cases of complete sarcoidosis have been reported, especially in patients treated with the TNF-α receptor protein, etanercept. This is intriguing because the TNF-α antibody drugs infliximab and adalimumab are reportedly used to treat sarcoidosis. We present three patients who developed sarcoidosis while on etanercept treatment, and discuss if possible differences in cytokine profiles and T regulatory cell function in patients taking different TNF-α inhibitors may explain this paradox.