Osteoprotegerin serum levels in Kawasaki disease: an additional potential marker in predicting children with coronary artery involvement

OBJECTIVE: Emerging evidence from in vitro studies and mouse genetics attributes to osteoprotegerin (OPG), a member of the tumor necrosis factor receptor family, an important role in vascular biology. We evaluated serum levels of OPG in a group of children with Kawasaki disease (KD), before immunoglobulin (IVIG) infusion and at 3-month followup. METHODS: Fifty patients (38 boys, 20 girls, median age 3.6 yrs, range 4 mo-7.4 yrs) fulfilling criteria for the diagnosis of KD, 30 febrile controls with infectious diseases, 18 patients with juvenile systemic lupus erythematosus (JSLE), and 40 healthy controls were enrolled. All KD patients received IVIG treatment within the first 10 days of illness, and aspirin. Coronary artery abnormalities (CAA) were reported in 6 out of 58 patients; all were male and younger than 5 years. Serum OPG was measured by ELISA in patients with KD before IVIG and at 3-month followup (median time 3.2 mo, range 3-3.5). RESULTS: At baseline and at the 3-month followup, KD patients had significantly higher OPG serum levels than febrile controls (p < 0.001 and p < 0.004, respectively), JSLE patients (p < 0.0001), and healthy controls (p < 0.0001). At baseline, KD patients who developed CAA had higher OPG serum levels than those without CAA (p = 0.0001); this difference was not present at 3-month followup. The optimal OPG cutoff value of 123.2 pg/ml was a significant predictor for CAA, with a sensitivity of 100% (6/6), a specificity of 96% (50/52), and a positive predictive value of 75% (6/8). CONCLUSION: High OPG levels might be the result of compensatory production during acute and subacute phases of KD. OPG assay might be an additional clinically useful marker to monitor and differentiate patients who develop, from those who do not develop, such coronary artery abnormalities.     

Incidence of blindness in southern Germany due to glaucoma and degenerative conditions

PURPOSE: To estimate population-based incidence rates of registered blindness separately, to determine its main causes. METHODS: The files of all newly registered blindness-allowance recipients in Württemberg-Hohenzollern, Germany (population: approximately 5 million), between 1994 and 1998 were reviewed. From ophthalmological reports on file the fulfillment of the German criteria for blindness (visual acuity of 1/50 or less or equivalent reduction of visual function) was ascertained, and the causes of blindness were obtained. Incidence rates of blindness due to macular degeneration, glaucoma, cataract, optic atrophy, and diabetic retinopathy were estimated. RESULTS: There were 3531 newly registered blindness-allowance recipients (67.1% female; mean age, 72.8 +/- 21.0 years). Standardized incidence rates in the general population (per 100,000 person-years; 95% confidence interval): All causes 12.27 (11.87-12.68), macular degeneration 5.29 (5.02-5.55), cataract 3.32 (3.11-3.52), optic atrophy 2.86 (2.66-3.05), glaucoma 2.43 (2.25-2.61), diabetic retinopathy 2.13 (1.96-2.30), other or unknown causes 5.17 (4.91-5.43). In many cases, blindness was attributable to more than one cause. Assuming that incidence rates are the same in other parts of the country, 9,939 (9,608-10,270) new cases of blindness were estimated to occur in Germany per year. CONCLUSIONS: The most common single cause of blindness was macular degeneration. Incidence rates of blindness due to such treatable conditions as glaucoma were also high. This finding suggests that the taking of measures for secondary prevention (e.g., early detection and optimal treatment of patients with glaucoma and diabetic retinopathy) should be intensified.     

Influence of maternal magnesium sulphate and ritodrine treatment on cerebral blood flow velocity of the preterm newborn

BACKGROUND: To evaluate the effect of antenatal tocolytic administration of magnesium sulphate and ritodrine on the cerebral blood flow velocity and on the cerebral vascular resistance of preterm newborns in the first hours of life. METHODS: Cerebral blood flow velocity, resistance index and relative vascular resistance were studied in 27 preterm infants (<34 weeks gestation) with antenatal exposure to maternal magnesium sulphate treatment and in 27 preterm infants (<34 weeks gestation) with antenatal exposure to maternal ritodrine treatment. Both antenatal magnesium sulphate or ritodrine were used for tocolysis. Cerebral blood flow was measured, using Doppler ultrasonography, in the anterior cerebral artery, in the left middle cerebral artery and in the right middle cerebral artery. RESULTS: We did not find any significant difference in the blood flow velocity, resistance index or relative vascular resistance in the three cerebral arteries between the two treatment groups. CONCLUSIONS: Our study shows that maternal antenatal administration of magnesium sulphate to delay preterm delivery, compared to antenatal administration of ritodrine, does not induce any significant differences either in cerebral blood flow velocity or in cerebral vascular resistance of preterm infants in the first hours of life.     

Occupational asthma due to metoclopramide hydrochloride (MCPH)

Metoclopramide hydrochloride (MCPH) is dopamine antagonist antiemetic drug that binds D2 receptor at the central nervous system and peripheral levels, which stimulates the upper gastrointestinal tract motility. It is often used in the management of some forms of nausea and vomiting (1-3). Occupational allergy to drugs is seldom reported. No case of occupational allergy to MCPH have been reported, to date. We present a case of airborne allergic asthma in a worker employed in the synthesis of Metoclopramide hydrochloride.     

Endocrinological study of the dopaminergic regulation of prolactin release in metastatic breast cancer

AIMS AND BACKGROUND: Prolactin (PRL) may be a growth factor for breast cancer. Abnormally high levels of PRL have been proven to be associated with a poor prognosis in metastatic breast cancer. However, most studies have been limited to the evaluation of basal levels of PRL rather than its response to the classical endocrine dynamic tests. This study was performed to analyse the dynamic secretion of PRL under stimulatory and inhibitory tests in metastatic breast cancer. METHODS: The study included 10 untreated metastatic breast cancer women, who were evaluated after the classical stimulatory and inhibitory tests for PRL secretion with the antidopaminergic agent Metoclopramide (10 mg iv as a bolus) and with L-dopa, respectively. Serum levels of PRL were measured by RIA before and at subsequent intervals after drug administration. PRL levels were considered to be elevated when they were higher than 25 ng/ml. RESULTS: Abnormally high basal levels of PRL were seen in 6/10 patients. L-dopa was unable to inhibit PRL secretion, whose mean concentrations paradoxically significantly increased in response to L-dopa, with values comparable to those observed after the classical stimulatory test with metoclopramide. CONCLUSIONS: This study confirm the existence of hyperprolactinemia associated with metastatic breast cancer. In addition, by showing a paradoxical rise of PRL in response to L-dopa, which inhibits PRL secretion in physiological conditions, this study would suggest that breast cancer-related hyperprolactinemia may depend at least in part on endogenous disease-related neuroendocrine alterations.     

Are symptoms of depression more common in diabetes? Results from the Heinz Nixdorf Recall study

Aims To estimate the association between depressive symptoms and Type 2 diabetes, as well as previously undetected diabetes, in a large population‐based sample in Germany and to determine associated variables. Methods We used baseline data on 4595 participants (age 45–75 years, 50.2% women) from the German Heinz Nixdorf Recall study, a population‐based, prospective cohort study which started in 2000. Diabetes mellitus was assessed by self report (physician diagnosis or medication), undiagnosed diabetes based on blood glucose levels. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES‐D) scale short form (cut‐off ≥ 15 points). We fitted multiple logistic regression models. Results The prevalence of diagnosed and previously undetected diabetes was 9.3% (95% confidence interval 8.2–11.6) and 7.6% (6.6–8.8) in men and 6.0% (5.1–7.1) and 3.2% (2.5–4.0) in women, respectively. Compared with non‐diabetic women, the prevalence of depressive symptoms was not significantly different in diabetic women (age‐adjusted odds ratio, 95% confidence interval 1.48; 0.98–2.24) and women with undiagnosed diabetes (0.67; 0.33–1.36). In men, the prevalence of depressive symptoms tended to be lower in diabetic than in non‐diabetic subjects (0.62; 0.35–1.09), but the depressive symptoms were significantly less frequent in men with undiagnosed diabetes (0.30; 0.13–0.70). The pattern remained after further adjustment. Significant associations with depressive symptoms were found for co‐morbidities and living without a partner in both women and in men, and for body mass index and activity level in women only. Conclusions After adjustment for relevant covariates, the association between depressive symptoms and Type 2 diabetes was heterogenous in our population‐based study. In subjects with undiagnosed diabetes, however, depressive symptoms were less frequent in men. Co‐morbidities and psychosocial conditions are strongly associated with depressive symptoms.     

Painless extra-corporal shock wave lithotripsy using the HM3 Dornier lithotripter

In a clinical study with a modified shock wave generator supplied by Dornier Medizintechnik for the Dornier Kidney Lithotripter HM3 the requirement of analgetics decreased significantly during Opioid-Analgesia. It could be shown that Extra-corporal Shock Wave Lithotripsy is possible without a central acting drug. Furthermore, a reduction of perioperative morbidity could be observed with the new generator.     

Undiagnosed diabetes mellitus among patients with prior myocardial infarction

Objective To determine the prevalence of undiagnosed diabetic subjects in a group of long-term myocardial infarction (MI) survivors and to investigate their cardiovascular risk factors and medical care. Methods Glucose tolerance (OGTT WHO 1985), cardiovascular risk factors (blood pressure, lipids, urinary albumin), and primary medical care during the previous year were assessed among 244 patients without previously known diabetes (mean age±SD: 70.5±6.9 yrs; 75% males; time since incident infarction: 6.5 years (median), inter-quartile range: 4–9 years) from the population-based MONICA myocardial infarction registry in Augsburg (Germany). Results Proportion of undiagnosed diabetes among MI registry patients was 29/244, 12% (95%CI: 8–17%); impaired glucose tolerance was found in 27% (22–34%). Using fasting glucose according to ADA 1997 criteria, 11% (7–16%) had diabetes and 17% (12–22%) impaired fasting glucose. MI registry patients with newly detected diabetes (WHO or ADA) showed a more adverse risk factor profile (higher triglycerides, lower HDL-cholesterol, increased urinary albumin) than subjects with normal glucose tolerance after controlling for possible confounders (age, sex, time since MI, antihypertensive and lipid-lowering medication). No significant differences were observed for self-reported medical care during the previous year among diabetic compared to non-diabetic subjects (number of physician visits and basic investigations). Conclusions There was a high prevalence of undiagnosed diabetes mellitus among the selected elderly long-term MI survivors. Because mortality rate after MI has been previously shown to be increased in diabetic patients, screening for glucose intolerance appears to be as essential as for standard cardiovascular risk factors.     

Effects of CDP-choline on platelet aggregation and the antiaggregatory activity of arterial wall in the rat

The effects of the acute (250 mg/kg) and chronic (250 mg/kg for two weeks) treatments with CDP-choline on platelet aggregation and thromboxane formation and on the platelet antiaggregatory activity of thoracic aorta, have been studied in the rat. The acute administration resulted mainly in reduced platelet reactivity to aggregating agents, with no change of platelet thromboxane formation. The antiaggregatory activity of aortic walls was also concomitantly reduced. After chronic treatment, the major effect was a greater antiaggregatory activity of the vessel wall in respect of the control values, whereas platelet function was not affected. CDP-choline treatment, thus exerts favourable effects especially in the acute treatment, by reducing platelet reactivity.