Biochemical and serological characteristics of children with membranous nephropathy due to hepatitis B virus infection: correlation with hepatitis B e antigen, hepatitis B DNA and hepatitis D

Fourteen children with biopsy-proven membranous nephropathy associated with hepatitis B virus (HBV-MN) were evaluated biochemically and serologically and compared to 45 children with idiopathic nephrotic syndrome (INS). The mean ages of the two groups were similar (4.9 +/- 1.6 vs. 4.6 +/- 2.6 years). Serum albumin levels were similar in both groups, but serum cholesterol was significantly reduced in children with HBV-MN compared to INS. Serum C3 was also significantly depressed in children with HBV-MN compared to INS, but no differences in C4 levels were noted. Serum alanine transaminase as well as aspartate transaminase concentrations were significantly elevated in children with HBV-MN compared to those with INS, suggesting the presence of chronic hepatitis in children with HBV-MN. Hepatitis B surface and e antigens were present in serum of all children with HBV-MN, but only 54% had circulating HBV-DNA particles demonstrable in their serum. Serum C3 levels were higher in children with HBV-MN and circulating HBV-DNA, compared to those without circulating HBV-DNA. No other serological or biochemical differences occurred between these two groups. Glomerular deposition of IgG and C3 occurred in 91% of children with HBV-MN; but IgM deposition appeared to occur more frequently and with greater intensity in those children positive for circulating HBV-DNA. Antibody to delta antigen was negative in all children with HBV-MN. We conclude that biochemical and serological differences can be identified between HBV-MN and INS.(ABSTRACT TRUNCATED AT 250 WORDS)     

Influence of laryngoscope design on heart rate and rhythm changes during intubation

One hundred and twenty adult patients about to undergo surgery were premedicated with either meperidine or meperidine and atropine. After anaesthesia was induced with thiopentone and succinylcholine given, tracheal intubation was performed with the use of either a Magill or a Macintosh laryngoscope. There were no statistical differences in changes of heart rate and rhythm between the groups, as regards the type of premedication given or the design of laryngoscope used.     

Improvement of the solubility of problem drugs. 1. Production of iomeglamic acid fused and solidified products

The insoluble X-ray diagnostic iomeglamic acid could be converted to a more soluble modification by melting and solidifying it in liquid nitrogen. The amorphous state is proved by X-ray diffraction and differential thermal analysis. During storage, recristallisation of the product appears. By means of the proved amorphous state, it seems possible to determine the amount of the amorphous state, which makes the drug more soluble from solid dispersions.     

Analysis of antibody reactivities toward self antigens of IgM of patients with Waldenstrom's macroglobulinemia

By using a quantitative immunoblotting technique, we have analyzed the repertoires of antibody reactivities of IgM directed toward self antigens in the serum of patients with Waldenstrom's macroglobulinemia (WM) and in the serum of healthy adults. Monoclonal IgM of patients with WM expressed various degrees of polyreactivity and a high degree of heterogeneity with regard to the number and the nature of the protein bands that were recognized in homologous tissue extracts. Heterogeneous patterns of reactivity of WM IgM contrasted with the conserved profiles of reactivity of IgM in the serum of healthy blood donors. Protein bands that were recognized by WM IgM belonged to the restricted set of self antigens recognized in homologous tissues by normal polyclonal IgM, indicating the absence of a disease-specific reactivity profile of monoclonal WM IgM. Thus, monoclonal IgM that is present in large amounts in WM distorts the homogeneous pattern of reactivity of natural antibodies with self antigens which characterizes the natural antibody repertoire of healthy individuals.      

Ambulatory electrocardiographic recording in mild or moderate myotonic dystrophy and myotonia congenita (Thomsen's disease)

Ambulatory electrocardiographic recording (AER) was performed on 27 adult patients with mild or moderate myotonic dystrophy (MD) and in 12 adult patients with mild myotonia congenita (MC) to determine whether characteristic arrhythmias and conduction disturbances occur in the early stages of these myotonic disorders. In MD and MC, AER showed at least one finding regarded as normal in 93% and 0% of cases, respectively. The most common abnormalities in MD were first degree atrioventricular (A-V) block (in 70% of cases) and QTc greater than or equal to 0.46 s (in 33%). Abnormal sinus intervals and frequent second degree A-V block were rare, each occurring in 4% of patients. Ventricular tachycardia did not occur. It is concluded that signs of involvement of cardiac conductive tissue in the MD disease process are very common, even in the early stages. Delayed A-V conduction in the most common single finding. Sinus nodal dysfunction, severe disturbances in A-V conduction, and ventricular arrhythmias are not common in mild disease. Repeated AER is indicated, to evaluate whether conduction disturbances in MD are progressing.     

Effects of petroleum hydrocarbon solvents on alkaline phosphatase of rats

After administration of benzene, gasoline, IOMEX or petroleum ether, liver alkaline phosphatase showed over 200% increase in activity whereas kidney alkaline phosphatase activity was depressed by 50%. The pattern of separation of isoenzymes of alkaline phosphatase in liver, kidney and serum indicated involvement of one of the isoenzymes. A simple method of detecting the incipent toxicity is described.     

Mortality risk stratification in chronic kidney disease: one size for all ages?

Current National Kidney Foundation Kidney Disease Outcomes Quality Initiative staging criteria for chronic kidney disease (CKD) are intended to apply to all age groups. However, it is unclear whether different levels of estimated GFR (eGFR) have the same prognostic significance in older and younger patients. The study cohort was composed of Department of Veterans Affairs (VA) patients who were aged 18 to 100 yr and had at least one outpatient serum creatinine measurement between October 1, 2001, and September 30, 2002 (n=2583,911). Patients with ESRD were excluded. GFR was estimated using the Modification of Diet in Renal Disease equation using each patient's first outpatient creatinine measurement during the study period. The association of eGFR with survival was measured by age group. Twenty percent of cohort patients had an eGFR<60 ml/min per 1.73 m2, ranging from 3% among 18- to 44-yr-olds to as high as 49% among 85- to 100-yr-olds. Fifty-two percent (n=266,421) of cohort patients with an eGFR<60 ml/min per 1.73 m2 had "very" moderate reductions in eGFR into the 50- to 59-ml/min per 1.73 m2 range. The association of eGFR with mortality was weaker in the elderly than in younger age groups: Whereas severe reductions in eGFR were associated with an increased risk for death in all age groups, "very" moderate reductions in eGFR (50 to 59 ml/min per 1.73 m2) were associated with an increased adjusted risk for death only among patients who were younger than 65 yr. Age-related attenuation of the association of eGFR with mortality was also present among women and black patients. In the clinical setting, mortality risk stratification in elderly patients should not be based on the same eGFR cut points as for younger age groups and would benefit from finer categorization of the 30- to 59-ml/min per 1.73 m2 eGFR group.