3,4-DGE in peritoneal dialysis fluids cannot be found in plasma after infusion into the peritoneal cavity.

OBJECTIVE: Glucose degradation products (GDPs) are important in the outcome of peritoneal dialysis (PD) treatment. 3,4-dideoxyglucosone-3-ene (3,4-DGE) is the most cytotoxic GDP found in conventionally manufactured fluids and may, in addition, be recruited from 3-deoxyglucosone (3-DG). It is not known what happens with those GDPs in patients during PD. The aim of this study was to investigate if the 3,4-DGE and 3-DG in PD fluids can be found in plasma during treatment. DESIGN: PD patients were dialyzed with a conventional PD fluid containing 43 micromol/L 3,4-DGE and 281 micromol/L 3-DG. Parallel experiments were performed in rats as well as in vitro with human plasma. The rats were dialyzed with a PD fluid containing 100 micromol/L 3,4-DGE and 200 micromol/L 3-DG. RESULTS: The concentration of 3,4-DGE in the peritoneum decreased at a much higher rate than 3-DG during the dwell. 3,4-DGE was not, however, detected in the plasma of patients or rats during dialysis. The concentration of 3-DG in plasma peaked shortly after infusion of the fluid to the peritoneal cavity. The concentration of 3,4-DGE during experimental incubation in plasma decreased rapidly, while the concentration of 3-DG decreased only 10% as rapidly or less. CONCLUSION: 3,4-DGE could not be detected in plasma from either PD patients or rats during dialysis. This is presumably due to its high reactivity. 3-DG may, on the other hand, pass through the membrane and be detected in the blood.     

Clinical importance of confirming or excluding the diagnosis of chronic graft-versus-host disease.

Chronic graft-versus-host disease (cGVHD) is a major complication of allogeneic hematopoietic cell transplantation. The presentation of this disease is varied, and it requires histological confirmation for diagnosis. In addition, cGVHD can often mimic other diseases, and vice versa. We have conducted a retrospective analysis of 123 patients referred to the GVHD clinic at the Johns Hopkins Oncology Center from 1994 to 1998 with a diagnosis of active cGVHD. Of these, nine patients (7%) had no evidence of cGVHD, and 25 patients (20%) had inactive cGVHD. Many of these patients were found to have other processes accounting for their ongoing symptoms. We conclude that since the therapy for this disease has significant toxicities and since what appears to represent cGVHD may actually be another disease, correct diagnosis of cGVHD or exclusion of this diagnosis is essential.     

Headache and dysfunction of the masticatory system in adolescents

An epidemiologic group of 285 17-year-old adolescents was studied with the aid of a questionnaire for frequency and intensity of headache and for symptoms of dysfunction of the masticatory system. They were also subjected to a functional examination of the masticatory system. Recurrent headaches occurred significantly more often among the girls (18%) than the boys (6%). Girls also reported significantly more intense headaches than boys. Fatigue in the jaws and difficulties in chewing were commoner in those with frequent and more intensive headaches. Tenderness to palpation of the masticatory muscles and impaired mandibular mobility were significantly commoner findings among those with recurrent headaches and those with more intense headaches. Tooth-grinding and clenching were related to frequency but not to intensity of headache. The investigation showed a significant relationship between frequency and intensity of headaches and signs and symptoms of dysfunction of the masticatory system.     

Follow-up of surgical therapy in patients with threatened and acute myocardial ischemia for an average of 5 years

Out of a total group of 300 patients after local intracoronary fibrinolysis, systemic ultra-high short-term fibrinolysis and instable angina pectoris 73 (24% out of 300) patients, in whom acutely or in the course of the treatment a surgical therapy of their coronary heart disease was performed, were analysed. Constellations of the findings of the coronary heart disease, when according to this connection with an adequate conservative therapy on the basis of a diagnostic and therapeutic step programme in 44% of the patients an improvement of the load capacity and in 73% an improvement of the subjective well-being is to be stated. In patients with diseases of one vessel compared with patients with diseases of several vessels significantly more frequently an intraindividual increase of the bicycle-ergometric performance develops.     

Response of rat cerebral cortical astrocytes to freeze- or cobalt-induced injury: an immunocytochemical and gap-FRAP study

Astrocytic response in the immediate vicinity of freeze- and cobalt-induced lesions has been examined at the light and ultrastructural level. However, the temporal and spatial distribution of astrocytic reactivity throughout the rat cerebral cortex, using glial fibrillary acidic protein (GFAP) immunolabeling, has not been examined. The first purpose of this study was to establish the chronological distribution of astrocytic reactivity, as measured by changes in GFAP immunoreactivity, following freeze- or cobalt-induced injury to the rat cerebral cortex. Cobalt metal also has been proposed to have a direct effect on astrocytes and has been shown to stimulate in vitro astrocytes to become reactive. The second purpose of this report was to determine if cobalt had an effect on in vitro astrocytic gap junctional dye coupling as measured by fluorescence recovery after laser-photobleaching (gap-FRAP). Although the chronological development of the increased GFAP immunoreactivity was different for the freeze- and cobalt-induced lesions, astrocytes initially showed an increase in GFAP immunoreactivity in the region surrounding these lesions. This initial response was followed by a spread of increased GFAP immunoreactivity throughout certain regions of the ipsilateral cerebral hemisphere and then by a restriction of the increased immunolabeling to the lesion site. Cobalt also had a direct effect on in vitro astrocytes as demonstrated by the inhibition of astrocytic gap junctional dye coupling. Based on gap-FRAP analysis, cobalt significantly blocked fluorescence recovery (2.5%) as compared to the fluorescence recovery in control astrocytes (26%). It is proposed that the initial increase in GFAP immunoreactivity may be due to decreased gap junctional activity.     

Prevalence,socio-demographic and clinical predictors of post-diagnostic utilisation of different types of complementary and alternative medicine (CAM) in a nationwide cohort of Danish women treated for primary breast cancer

AimThis study investigated the prevalence and predictors of use of complementary and alternative medicine (CAM) in a nationwide inception cohort of Danish women treated for early-stage breast cancer as well as differences in user patterns for individual types of CAM.MethodsUse of CAM since the time of diagnosis was assessed 12–16 weeks post-surgery for the 3343 women (age 18–70) included in the study (response rate: 68%). Socio-demographic and clinical variables were obtained from national longitudinal registries.Results40.1% of the women had used one or more types of CAM. Users were younger than non-users. Age adjusted analyses showed that CAM users were characterised by absence of comorbidity, higher educational level, higher personal income, higher social status, being divorced/separated and living in the metropolitan area of Copenhagen. Multivariate analyses revealed that chemotherapy was the only clinical and treatment-related predictor of CAM use, and that CAM users were more likely to be of normal weight and non-smokers. Of CAM users, 33.7% believed that CAM would have a positive influence upon their breast cancer. Different characteristics distinguished users of individual types of CAM.ConclusionThe results of this first nationwide study of utilisation of CAM in breast cancer show that CAM users are healthier and more likely to have higher socio-economic status than non-users. Different user patterns for individual types of CAM may be overlooked, when different types of CAM are treated as one homogeneous category.     

Improved hand function in a dental hygienist with neuropathy induced by vibration and compression: the effect of cutaneous anaesthetic treatment of the forearm.

We report a case of neuropathy induced by vibration and compression in the hand of a dental hygienist. Her hand function was improved considerably by repeated treatment during which EMLA cream (EMLA cream is a local anaesthetic agent containing lidocain 2.5% and priolocain 2.5%) was applied to the forearm to induce cutaneous anaesthesia.     

Can both EDTA and citrate plasma samples be used in measurements of fibrinogen and C-reactive protein concentrations?

BACKGROUND: Fibrinogen and C-reactive protein (CRP) concentrations are predictors of outcome in the atherosclerotic patient. It is important in risk stratification that these quantities are measured reproducibly in routine and research. METHOD: In the present study, we compare measurements of fibrinogen and high-sensitivity CRP in EDTA and citrate plasma samples (n=150) using nephelometric immunoassays. Fibrinogen was also measured in citrate plasma using a clotting method. RESULTS: In approximately one-third of the samples, the fibrinogen concentration measured by immunoassay was higher in citrate plasma than in EDTA plasma, in spite of the dilution by citrate. The immunoassay results of fibrinogen concentration measurements in EDTA and citrate plasma differed significantly and also differed from those of functionally measured fibrinogen concentrations. A difference was found between the concentration of CRP in EDTA plasma and citrated plasma which also did not correspond to the dilution. CONCLUSIONS: Reproducibility of results is essential in risk stratification by fibrinogen or high-sensitivity CRP concentrations and small differences close to the decision limits may have a decisive impact. Immunological measurements are liable to confounding effects that may be difficult to foresee, qualitatively and quantitatively. Great care should be observed when measuring the concentration of calcium containing analytes in anticoagulated samples. Fibrinogen concentrations should preferably be measured functionally in citrate plasma.