Trace elements in head and neck cancer patients: Zinc status and immunologic functions

In this study we have assessed zinc status and zinc-dependent cell-mediated immune functions (interleukin-2 production by mononuclear cells, natural killer cell lytic activity, and interleukin-1β production by mononuclear cells) in adult patients with squamous cell carcinoma of the upper aerodigestive tract at diagnosis and before any therapy was instituted. Inasmuch as significant interactions between zinc, copper, and iron exist, we also assayed the plasma copper level, serum iron level, and total iron-binding capacity in our patients. We recruited 30 cancer subjects and 21 control subjects. On the basis of cellular zinc criteria, we diagnosed a mild deficiency of zinc in 53% of cancer subjects. The plasma zinc level was not decreased in our subjects. A univariate analysis was applied by use of one-way analysis of variance comparing study variables among the three study groups (controls and zinc-deficient and zinc-sufficient cancer patients) and Tukey’s multiple comparison test, and we showed that interleukin-2 production and natural killer lytic activity were decreased in zinc-deficient cancer patients. Interleukin-1β production (ELISA assay) was increased in both zinc-deficient and zinc-sufficient groups. Plasma copper level was not different, but the iron utilization was decreased in both groups of cancer subjects. We conclude that zinc deficiency and zinc-dependent immunologic dysfunctions are present in more than half of the patients with head and neck cancer in the Detroit area. (Otolaryngol Head Neck Surg 1997;116:624-9.)     

Umbilical Arterial Doppler Indices in Acute Uteroplacental Flow Occlusion

This study was undertaken to investigate in an acute model the effects of acute transient occlusion of the uterine blood flow on the umbilical arterial Doppler indices. Transient uteroplacental circulatory insufficiency was produced in five pregnant ewes (gestational age 115–120 days) by reversible mechanical occlusion of the common hypogastric artery for 20 seconds. The Doppler indices measured were the systolic-diastolic ratio, the pulsatility index and the resistance index. The duration of the cardiac cycle and its systolic and diastolic times were approximated from the Doppler waveform. The occlusion produced transient increases in the Doppler indices and cardiac cycle time. The uteroplacental circulatory insufficiency induced increases (P < 0.005) in the Doppler indices disappeared (P > 0.05) when the latter were corrected for the changes in the cardiac cycle time. Furthermore, diastolic time was the main component of the changes in the cardiac cycle time, and the Doppler indices demonstrated a higher correlation with diastolic time than with systolic time. The results verified that changes in the duration of the fetal cardiac cycle play an important role in shaping the umbilical arterial Doppler waveform and hence need to be taken into account in estimating the Doppler indices.     

A double-blind comparison of bisoprolol and atenolol in patients with essential hypertension

We compared the ß₁-selective adrenoceptor antagonistsbisoprolol and atenolol in a double-blind, randomized crossoverstudy. After 4 weeks placebo phase, 59 patients with essentialhypertension received either 10 mg bisoprolol or 50 mg atenololonce daily for 8 weeks, increased if necessary (target BP 150/90mmHg) to 20 and 100 mg, respectively, after 4 weeks. After asecondplacebo phase, crossover occurred to the alternative drug. Wemeasured resting systolicand diastolic blood pressures and heartrate at 24 h post-dose baseline and after 4 and 8 weeks treatment.Both drugssignificantly lowered systolic and diastolic bloodpressures and heart rate at 8 weeks compared to baseline (allp <0.05). Bisoprololreduced heart ratesignificantly morethan atenolol (p <0.01), but systolic and diastolic bloodpressure changes were not different between the two drugs. Therewas no difference in patient acceptability of the drugs as assessedby visual analogue scale. Despite theoreticaland circumstantialevidence to suggest superiority of bisoprolol over atenolol,no significant difference between the two was found except forgreater heart rate reduction with bisoprolol.     

COMPARISON OF THE OCULAR EFFECTS OF ATROPINE OR GLYCOPYRROLATE WITH TWO I.V. INDUCTION AGENTS

Atropine and glycopyrrolate combined with either methohexitoneor thiopentone were compared with the induction agent alonein patients undergoing electroconvulsive therapy. Patients actedas their own controls in each sub-group defined by inductionagent. Pupil size, muscle twitches, presence of hiccups andthe extent of oropharyngeal secretions were noted. Methohexitoneproduced a greater and more prolonged increase in pupil sizethan did thiopentone. The subsequent pupil size following theatropine-methohexitone mixture was significantly greater thanthat following the glycopyrrolate-methohexitone mixture. Thecombination of atropine with thiopentone produced a greater"secondary" mydriasis than thiopentone alone, or thiopentonecombined with glycopyrrolate. The effect of the glycopyrrolate-thiopentonecombination did not differ significantly from that of thiopentonealone. Methohexitone was associated with a greater incidenceof hiccups, muscle twitching and excessive salivation.     

Functional renal reserve capacity in different stages of chronic kidney disease

Aim: There is conflict in published reports on the extent of availability of the functional renal reserve (RR) in healthy adults and in various stages of chronic kidney disease (CKD). The aim of the present study was to determine the RR in various stages of CKD. Methods: Baseline glomerular filtration rate (GFR) and ‘stimulated GFR’ following amino acid infusion were measured in 25 volunteers and 100 patients at various stages of CKD by measuring plasma clearance of Tc99m diethyl triamine pentaacetic acid. Any obtained difference between stimulated and basal GFR was considered as RR and expressed as percentage. Results The mean renal reserve was 23.4% in the healthy control group, 19.08% in CKD stage 1, 15.4% in CKD stage 2, 8.9% in CKD stage 3 and 6.7% in CKD stage 4, respectively. Conclusion: Renal reserve falls relentlessly with progression of CKD from 23.4% in normal to 6.7% in stage 4 CKD. However, RR may also get completely exhausted even with a normal or with a minimal decline basal GFR. Kidneys may retain some RR even up to the GFR level of 15 mL/min.