Beitrag zur Histogenese der aus aberrirten Nebennierenkeimen entstandenen Nierengesch wülste

Ohne ZusammenfassungHierzu Taf. X.     

Visual prognosis of second eyes in patients with unilateral late exudative age-related macular degeneration

PURPOSE: A prospective longitudinal study was initiated to analyze the correlation between the prognosis for the second eyes of patients with unilateral late exudative AMD and the disease phenotype. METHODS: Of the187 patients with unilateral late exudative AMD recruited, 130 (69.5%) had predominantly classic CNV without pigment epithelium detachment (PED) (CNV group), and 57 (30.5%) had occult CNV with serous PED (PED group). Patients were reexamined by ophthalmoscopy and angiography every 6 months for up to 80 months. The end point was ETDRS visual acuity change of 3 lines or more due to late AMD in the second eye. RESULTS: During follow-up 53 (28.3%) patients reached the end point: 32 (24.6%) in the CNV group and 21 (36.8%) in the PED group. The major prognostic factor for the risk of visual loss in the second eye was the type of late AMD in the first eye (CNV group 6-7% per year, PED group 15-16% per year ( P<0.001). There was significant symmetry between the new exudative lesion in the second eye and that in the first, and significant differences in the density and fluorescence of drusen in the second eye between the two groups. CONCLUSIONS: Patients with occult CNV with serous PED in the first eye have a significantly higher risk of visual loss in the second eye than patients with CNV without PED. This distinction may be important for future clinical studies. In addition, segregation of AMD by phenotype is necessary in the analysis of genes conferring risk of AMD.     

Hypovitaminosis D, impaired bone turnover and low bone mass are common in patients with peripheral arterial disease

Hypovitaminosis D is common in patients with peripheral arterial disease (PAD). Subsequent secondary hyperparathyroidism and osteomalacia contribute to bone pain and myalgias, and so aggravate clinical symptoms of claudication. We evaluated 95 out of 297 patients with angiographically confirmed PAD stages II (pain in the calves and/or thighs only during exercise) or IV (history of, or presence of local ulcers) and compared them with 44 matched healthy controls regarding their medical history, bone density measurements of the femoral neck and calcaneal bone ultrasound. Bone pain, myalgias and mobility restriction as well as routine laboratory parameters, serum vitamin D [25(OH)D], crosslaps (CTX), parathyroid hormone (PTH), osteocalcin (OC) and alkaline phosphatase (AP) were recorded and analysed. 25(OH)D was significantly lower in PAD IV patients (9.6±4.6 ng/ml, P<0.0001) as compared to PAD II stages and controls (19.0±7.6 and 19.1±9.1 ng/ml), paralleled by lower serum calcium [2.24±0.02 mmol/l, P=0.0002 versus PAD II (2.36±0.02) and P<0.0001 versus controls (2.39±0.02)] and higher iPTH serum levels (66.3±3.6 pg/ml, P<0.0001) as compared to PAD II patients (45.3±3.5) and healthy controls (38.5±2.4). Alkaline phosphatase and serum crosslaps values were significantly higher and age-adjusted bone density and bone ultrasound measurements significantly lower in PAD IV patients, who were also twice as likely to have bone pain and myalgias as PAD II patients. Bone ultrasound measurements correlated significantly with both clinical severity and pain as well as serological parameters of bone metabolism. Underlying PAD has a significant impact on bone density and metabolism as well as on bone and muscular pain. Patients with PAD are at high risk for osteoporosis and osteomalacia and should be regularly monitored and treated for their vitamin D deficiencies.S. Kudlacek represents the Austrian Study Group on Normative Values of Bone Metabolism.     

Binding of prazosin and propranolol at variable alpha 1-acid glycoprotein and albumin concentrations.

1. The effect of variable alpha 1-acid glycoprotein (AAG) and albumin (HSA) concentrations on the binding of prazosin and propranolol was assessed in plasma after surgery and in mixtures of AAG/HSA with concentrations mimicking those found in vivo. 2. On the pre-operative day the binding of prazosin and propranolol was 94.8% and 89.0%, respectively and 97.3% and 93.2%, respectively, 5 days after surgery. 3. In solutions containing mixtures of highly purified AAG and HSA representing the pre-operative state, 88.6% and 83.9% binding of prazosin and propranolol was observed, whereas for solutions mimicking post-operative plasma, the equivalent values were 94.6% and 91.4%, respectively. 4. The ratios between bound and unbound concentrations of both drugs were closely correlated to the concentrations of AAG, but not to the concentrations of HSA. 5. The present study demonstrates that AAG is responsible for the binding variability of prazosin and propranolol in plasma from post-operative patients.     

Contrast-enhanced computed tomography to show perivesical extension in bladder carcinoma

Fifty-two patients (53 lesions) with muscle invasive carcinoma (T2/T3) of the urinary bladder were examined with computed tomography (CT) before planned total cystectomy. The object of CT was to demonstrate perivesical growth. All patients were examined before and after intravenous injection of contrast medium. The stages obtained from the precontrast and postcontrast scans were compared with the histopathologic stage from the cystectomy specimen. CT staged correctly 35 of the 53 lesions in the precontrast series and 46 of the 53 lesions in the postcontrast series. The improved accuracy from contrast enhancement resulted primarily from fewer cases being overstaged. The use of intravenous contrast medium improved accuracy of CT in evaluation of perivesical tumor growth.     

Normal regulation of elevated plasma ghrelin concentrations in dialysis patients

BACKGROUND: Chronic renal failure is often associated with malnutrition, and malnourished patients are subject to increased morbidity and mortality. Therefore plasma concentrations of the stomach-derived peptide hormone ghrelin, which has been shown to exert potent GH-releasing and appetite-stimulating effects, were determined and correlated with nutritional parameters. METHODS: Twenty-four patients (15 male, 9 female) undergoing hemodialysis (HD) were studied. In addition, six patients were studied before and one hour after ingestion of a meal and five were studied immediately before and at the end of the dialysis session. RESULTS: Chronic renal insufficiency was associated with significantly elevated ghrelin levels (320.1 +/- 57 fmol/mL vs. 75.6 +/- 12.4 fmol/mL in controls; p < 0.007). Plasma ghrelin concentrations were also significantly higher in the 16 normal-weight patients than in the eight overweight or obese patients (399.6 +/- 76.3 fmol/mL vs. 161.1 +/- 41.3 fmol/mL; p < 0.03). Ingestion of food induced a decrease in five out of six patients tested (mean 242.3 +/- 66.5 fmol/mL vs. 186 +/- 30.7 fmol/mL; n.s.). HD also resulted in a significant decrease of elevated ghrelin concentrations: ghrelin was in the normal range at the end of HD in four of the five patients tested. Plasma ghrelin concentrations did not correlate with nutritional parameters except for cholinesterase which was negatively correlated to ghrelin. CONCLUSION: Plasma ghrelin concentrations are elevated in HD. The fact that ghrelin concentrations are higher in normal-weight than in overweight or obese HD patients and suppressed after ingestion of a meal suggests that the regulation of ghrelin release is retained in HD patients, albeit shifted to a higher level.     

Simultaneous analysis of MDR1 C3435T, G2677T/A, and C1236T genotypes by multiplexed mutagenically separated PCR.

P-glycoprotein (PGP) encoded by the multi-drug-resistance 1 (MDR1) gene is a member of the ATP-binding cassette (ABC) transporter family, drug-transporting proteins involved in the bioavailability and pharmacokinetics of various drugs. Several single nucleotide polymorphisms (SNPs) in the MDR1 gene have been identified so far that may influence PGP expression levels and function. Thus, genotyping for MDR1 polymorphisms and determining specific haplotypes may become an important tool in predicting individual susceptibility to developing drug resistance. We developed a new multiplexed allele-specific PCR method based on the principle of mutagenically separated PCR (MS-PCR) for rapid and reliable simultaneous genotyping of the C3435T polymorphism in exon 26 of the MDR1 gene and two additional SNPs (G2677T/A in exon 21 and C1236T in exon 12), which are in linkage disequilibrium with MDR1 C3435T. The accuracy and reliability of this method was confirmed by sequencing the respective regions in the MDR1 gene. This newly developed MDR1 MS-PCR will facilitate fast, accurate and economic analysis of MDR1 genotypes and will provide important information in optimizing individual therapeutic approaches.