Role of adenosine in contrast media-induced acute renal failure in diabetes mellitus

Increased release of renal adenosine and stimulation of renal adenosine receptors have been proposed to be major mechanisms in the development of contrast media-induced acute renal failure (CM-ARF). Patients with diabetes mellitus or preexisting renal disease who have reduced renal function have a markedly increased risk to develop CM-ARF. This increased risk to develop CM-ARF in patients with diabetes mellitus is linked to a higher sensitivity of the renal vasculature to adenosine, since experimental studies have shown increased adenosine-induced vasoconstriction in the kidneys of diabetic animals. Furthermore, recent evidence suggests that administration of adenosine receptor antagonists reduces the risk of development of CM-ARF in both diabetic and nondiabetic patients. The purpose of this review is to discuss the role of adenosine in the development of CM-ARF, particularly in the kidneys of diabetic patients, and to evaluate the therapeutic potential of adenosine receptor antagonists in the prevention of CM-ARF. Selective adenosine A1 receptor antagonists may provide a therapeutic tool to prevent CM-ARF in patients with diabetes mellitus and reduced renal function.     

Effect of gamma-L-glutamyl-L-dopa on phosphate excretion

gamma-L-glutamyl-L-DOPA (gludopa) is a dopamine prodrug that is relatively specific for the kidney. Because dopamine is phosphaturic, the present study compared the phosphaturic effects of the infusion of equimolar doses of gludopa (n = 8), L-DOPA (n = 8), and gamma-L-glutamyl-L-tyrosine (glutyrosine, n = 6). Glutyrosine was used as a control to evaluate the effect of the glutamyl portion of gludopa on phosphate excretion. Sprague-Dawley rats (350 to 400 g) were anesthetized with 5-sec-butylethyl-2-thyobarbituric acid (Inactin; 100 mg/kg, IP) and underwent thyroparathyroidectomy. Clearances were taken during the infusion of normal saline vehicle, followed by the infusion of gludopa, L-DOPA, or glutyrosine, all infused at the rate of 10 nmol/kg bolus and 0.8 nmol/kg/min (iv). To determine the contribution of glutamyl derivative to phosphate excretion, gludopa or L-DOPA was infused in the presence of SCH23390, a DA-1 receptor antagonist. Gludopa infusion significantly increased dopamine excretion (from 1.9+/-0.2 ng/min to 17.0+/-3.9 ng/min, delta15.0+/-3.9 ng/min, P < .008) and fractional excretion of phosphate (from 2.6%+/-0.6% to 34.8%+/-1.8%, delta32.0%+/-1.6%, P < .001). L-DOPA infusion significantly increased dopamine excretion (from 1.4+/- 0.4 ng/min to 9.7+/-1.6 ng/min, delta8.3+/-1.5 ng/min, P < .001) and fractional excretion of phosphate (from 1.7%+/-0.6% to 8.2%+/-2.0%, delta6.4%+/-1.5%, P < .004). Glutyrosine infusion significantly increased fractional excretion of phosphate (from 2.8%+/-0.8% to 17.5%+/-5.2%, delta14.6%+/-4.8%, P < .03) without changing dopamine excretion (delta0.5+/-0.2 ng/min). Infusion of gludopa in the presence of SCH23390 increased fractional excretion of phosphate (from 5.7%+/-2.5% to 12.6%+/-3.5%, delta6.8%+/-2.3%, n = 6, P < .03), whereas SCH23390 completely blocked the phosphaturic effect of L-DOPA. We conclude that gamma-L-glutamyl-L-DOPA is more phosphaturic than L-DOPA in the rat because of the combined effects of dopamine and the glutamyl moiety.     

Clinical and Biochemical Evaluation of Patients with Hirsutism

Summary: Patients with moderate to severe hirsutism presenting over an 18-month period to an endocrine clinic were assessed by clinical evaluation and hormone measurements. Hair growth rate was estimated by a photographic technique and the severity of hirsutism graded using an objective scale. Of 43 patients, 9 had polycystic ovaries and the remainder were considered to have idiopathic hirsutism. The most severely affected group had significantly increased hair growth rates compared with less clinically affected subjects, and 47% of this group showed objective features of virilization. However, apart from a significantly higher 24-hr urine 17-ketosteroid excretion all other hormonal patterns were not significantly different between severely and mildly affected patients. Serum levels of testosterone (T), sex hormone-binding globulin (SHBG), free T (calculated from T and SHBG values), and androstenedione (A) were abnormal in 44%, 51%, 60% and 60% of patients respectively, whereas plasma levels of the specific adrenal androgen DHAS were increased in 40% of patients. There was an overlap between patients with elevated hormone levels, although isolated elevation of T, A or DHAS were seen in 9%, 19% and 3% of patients respectively. In 19% of patients all serum androgen measurements were normal. Gonadotrophin levels were significantly lower in the more severely affected group. Thus androgen levels in patients with idiopathic hirsutism or polycystic ovaries, show considerable overlap with measurements in normal subjects, and elevated plasma androgens may be of adrenal (DHAS) or combined adrenal/ovarian (T, A) origin.     

Changing incidence of infantile hypertrophic pyloric stenosis.

The incidence of infantile hypertrophic pyloric stenosis was measured in the West Midlands Health Region between 1974 and 1980. It increased from 2.1/1000 Caucasian births in 1974 to 3.5/1000 in 1980 and reflects a reported increase in Central Scotland. Several artefacts were excluded--for example, repeat admissions to the same hospital, transfers to other hospitals, and changes in treatment and in diagnostic standards. Two main demographic changes were excluded as explanations, ethnic changes and changes in the birth rank distribution. The increase is therefore considered real and may be related to changes in breast feeding practice.     

Absorbance of amniotic fluid at 650 nm as a fetal lung maturity test: A comparison with the lecithin/sphingomyelin ratio and tests for disaturated phosphatidylcholine and phosphatidylglycerol

We compared absorbance of amniotic fluid at 650 nm (A₆₅₀) against the lecithin/sphingomyelin ratio, the quantity of disaturated phosphatidylcholine, and the presence or absence of phosphatidylglycerol in 374 uncontaminated amniotic fluid samples. In addition, we studied these measures of fetal lung maturity in 80 pregnancies where neonatal outcomes were known. Statistical analysis revealed a significant association between increasing absorbance and biochemical indices of lung maturation. Our results indicate that A₆₅₀ of amniotic fluid is useful as a measure of lung maturity but that the greatest utility may be for samples with either low absorbance (<0.10) or high absorbance (>0.20). Because of large false positive and false negative values between these two absorbances, other lung maturity estimates should be used when absorbances fall within this range. Therefore, A₆₅₀ may be most useful as a screen or as part of a battery of lung maturity estimates. We are exploring these possibilities as a means of providing better fetal lung maturity estimates.     

Tooth agenesis: a report of missing molars in two generations

A recent review has suggested that tooth agenesis is becoming more evident in society, though it is not known whether this observation is related to better detection methods and patient awareness or whether there is a real trend towards an increase in prevalence. In this paper we report developmental absence of permanent molars in two generations, and discuss the possible clinical implications of this pattern of tooth agenesis.