Hepatic transport of bilirubin in rats with streptozotocin-induced diabetes

This study was undertaken to evaluate the effects of streptozotocin-induced diabetes on the hepatic transport of bilirubin in male Wistar rats. Rats were pretreated with streptozotocin (60 mg/kg i.p.) to induce uncontrolled diabetes. Six days later endogenous biliary excretion and plasma bilirubin concentration were significantly enhanced compared to control animals (+36% and +46%, respectively), while the blood levels of free hemoglobin remained unchanged. Following a bilirubin load, the maximal biliary excretion of the pigment (Tm) in diabetic animals was significantly enhanced compared to control animals (+49%). Liver and plasma bilirubin concentrations at the end of bilirubin administration were significantly reduced (-28% and -30%, respectively). Bilirubin UDP-glucuronosyltransferase activity and UDP-glucose concentration in liver were significantly enhanced (+31% and +81%, respectively), as was the biliary excretion of unconjugated bilirubin (+37%) and bilirubin mono- (+38%) and diconjugates (+53%). When streptozotocin-diabetic rats were treated with insulin, the parameters of bilirubin transport and metabolism were significantly reduced compared to diabetic animals receiving no hormone replacement. In summary, our data indicate that in short-term streptozotocin-diabetic rats there is increased bilirubin production as well as enhanced hepatic conjugation and subsequent biliary excretion of the pigment. These effects appear to be a direct consequence of diabetes.

Purification, characterization and some properties of diacetyl(acetoin) reductase from Enterobacter aerogenes

A new method, faster, milder and more efficient than the one previously described [Bryn, K., Hetland, O. & Stormer, F. C. (1971) Eur. J. Biochem, 18, 116-119], for purification of diacetyl(acetoin) reductase from Enterobacter aerogenes is proposed. The experiments carried out with the electrophoretically pure preparations obtained by this procedure show that the enzyme (a) produces L-glycols from the corresponding L-alpha-hydroxycarbonyls by reversible reduction of their oxo groups and also reduces the oxo group of uncharged alpha-dicarbonyls converting them into L-alpha-hydroxycarbonyls, and (b) is specific for NAD. This is a new enzyme for which we suggest the systematic name of L-glycol: NAD+ oxidoreductase and the recommended name of L-glycol dehydrogenase(NAD). The molecular mass, pI, affinity for substrates and pH profiles of this enzyme are also described.

Inhibition of biliary cholesterol and phospholipid secretion by cefmetazole. The role of vesicular transport and of canalicular events

A number of organic anions selectively inhibit the biliary secretion of cholesterol and phospholipids without affecting bile acid secretion. We studied the effect of cefmetazole, a third-generation cephalosporin, on biliary lipid secretion in the rat. Injection of cefmetazole at a dose of 200 mumol/kg body wt. induced a choleretic effect and a significant decrease in the biliary output of cholesterol and phospholipid, without changes in bile acid secretion. The decrease was more marked for cholesterol than for phospholipid secretion, with a significant decrease in their molar ratio in bile. The effects were apparently unrelated to an inhibition of intracellular vesicular transport because, after injection of horseradish peroxidase, both the time course and total amount secreted of the protein did not significantly differ between control animals and those receiving cefmetazole. The secretory rate of the lysosomal marker acid phosphatase was not affected by cefmetazole administration. Biliary outputs of the plasma-membrane enzymes alkaline phosphatase and gamma-glutamyltransferase were significantly decreased by the antibiotic. These results point to an effect of cefmetazole at the level of the canalicular membrane.

Lymphoma of the gastric stump: report of a case

We report a case of primary lymphoma on a previously resected stomach in a 62-year-old man. The patient was treated 22 years earlier with a partial gastrectomy and Billroth II reconstruction for a benign gastric ulcer. The rarity of this entity and its possible relationship with pseudolymphoma or lymphoid nodular hyperplasia is discussed, and the literature is reviewed.

Effect of norepinephrine on diaphragm contractility and blood flow

Recent studies have shown that diaphragm fatigue can be reversed by mechanical augmentation of phrenic arterial flow. The purpose of the present experiment was to determine whether it was possible to pharmacologically augment diaphragm blood flow and reverse fatigue by the administration of norepinephrine. Four groups of studies were performed, all employing our previously described in situ isometric canine diaphragm strip preparation (Supinski et al., J. Appl. Physiol. 60: 1789-1796, 1986). Group I studies examined the effects of norepinephrine on the contractility of the nonfatigued diaphragm in normotensive dogs, group II studies examined the effects of this drug on the contractility of the fatigued diaphragm in normotensive animals, and group III studies examined the effect of this drug on the contractility of the fatigued diaphragm in hypotensive animals. Group IV studies examined the effect of norepinephrine in normotensive animals in which the phrenic artery was cannulated and pump perfused at constant flow. Fatigue was induced in group II, III, and IV studies by rhythmically stimulating the diaphragm via intramuscular electrodes. Norepinephrine had no effect on the contractility of the nonfatigued diaphragm (group I). In normotensive (group II) and hypotensive animals (group III), norepinephrine elicited dramatic increases in arterial blood pressure and phrenic arterial flow and produced a significant upshift in the force-frequency curve of the fatigued diaphragm. However, when phrenic flow was held constant (group IV experiments), norepinephrine failed to augment the contractility of the fatigued diaphragm. These results indicate that 1) norepinephrine can increase phrenic blood flow and augment the contractility of the fatigued diaphragm in both normotensive and hypotensive conditions and 2) this effect of norepinephrine to partially reverse fatigue is secondary to its action to augment diaphragmatic blood flow.

Changes in the biliary excretion of organic anions following exhaustive exercise in rats

The effect of exhaustive exercise on the hepatobiliary transport of organic anions was investigated in rats. Animals were run on a rodent treadmill at 24 m/min up a 12% grade (152 +/- 15 min). Exercise resulted in significant hypoglycaemia (-46%) and increased plasma levels of lactate (+12%), together with a marked reduction of glycogen concentration in the liver (-72%). When bromosulphthalein was administered i.v., its maximal biliary excretion (Tm) was significantly reduced (-30%), and plasma and liver concentrations of the dye were increased (+31% and +56%, respectively). The decrease corresponded both to the excretion of the conjugated and unconjugated dye (-30% and -33%, respectively). Cytosolic glutathione S-transferase activity in the liver was not affected by exercise, but there was a significant reduction in the hepatic concentration of glutathione (-50%). The Tm of dibromosulphthalein was also significantly reduced (-36%) and its plasma and liver concentrations increased (+67% and +33%, respectively) in exercised rats. The results suggest that, in addition to the direct effect of liver glutathione depletion, other factors must be involved in the impairment of the biliary excretion of organic anions caused by exercise.

Spontaneous bacterial peritonitis due to Salmonella enteritidis in cirrhotic ascites

Spontaneous bacterial peritonitis due to Salmonella is uncommon. We report three patients with ascites infected by Salmonella. All three patients had advanced chronic liver disease, typically cirrhosis with portal hypertension. Salmonella enteritidis grew in the ascite fluid culture of the three patients. There was no clinical or microbiological evidence of Salmonella infection other than in the ascitic fluid. One patient died before antibiotic treatment was started, but the other two were treated with different combinations of antimicrobial drugs. One of them died on the fourteenth day of hospitalization, and the other survived.

Microdochectomy for discharge from a single lactiferous duct

Microdochectomy for persistent discharge from a single lactiferous duct was performed in 162 women. Invasive or in situ ductal carcinoma was diagnosed in 16 patients (10 per cent), none of whom had a palpable lump. The discharge was blood-stained in 14 of these women and in two it was clear. Mammography was performed in 15 of these 16 patients and was abnormal in only five. Three patients had atypical ductal hyperplasia, one of whom subsequently developed an invasive ductal carcinoma. Microdochectomy for persistent discharge from a single lactiferous duct is curative and gives a diagnosis of the cause. It remains the treatment of choice whether the discharge is blood-stained or clear.

An unusual case of intraparotid foreign body

Foreign bodies in salivary glands are an unusual event; foreign bodies simulating parotid tumors are an exceptional finding. A posttraumatic case of intraparotid foreign body and a brief literature review are presented.

Effects of ursodeoxycholate on maximal biliary secretion of bilirubin in the rat

The effect of sodium ursodeoxycholate (0.5 and 1.0 mumol/min/100 g) on the maximal biliary secretion (Tm) of bilirubin and on the concentration of bilirubin in liver and plasma at the end of a bilirubin load was studied in Wistar rats. Administration of ursodeoxycholate at 0.5 mumol/min/100 g caused a 0.8-fold increase in bile flow and a significant increase in the bilirubin Tm (+24%). This was associated with a significant reduction of liver and plasma bilirubin concentrations (-16% and -17%, respectively). Bilirubin UDP-glucuronosyltransferase activity was not significantly enhanced. There was a significant increase in the biliary excretion of bilirubin conjugates (+30%) and in the diconjugates/monoconjugates ratio in bile (+31%). When ursodeoxycholate was given at 1.0 mumol/min/100 g, it produced a 1.7-fold increase in bile flow, but the bilirubin Tm was significantly reduced (-21%). Liver bilirubin concentrations were decreased (-20%) and there was a significant enhancement in total pigment concentration in plasma (+19%). Both the excretion of unconjugated bilirubin and that of bilirubin conjugates were significantly reduced (-60% and -18%, respectively). There was a significant decrease in the bilirubin-UDP glucuronosyltransferase activity and the diconjugates/monoconjugates ratio in bile (-27% and -27%, respectively). These results indicate that ursodeoxycholate is able to increase maximal bilirubin secretion only when administered at low doses and that infusion at higher rates can significantly interfere with different steps in the hepatobiliary transport of the pigment.

A patient with hyperkalemia and metabolic acidosis

Uptake of potassium by extrarenal tissues, primarily muscle and liver, represents a major defense mechanism in the maintenance of normokalemia following an acute elevation in the serum potassium concentration. Insulin, epinephrine, and aldosterone all play major roles in maintaining the normal distribution of potassium between the intracellular and extracellular environment. In addition to hormonal regulation, changes in blood pH and tonicity also exert a strong influence on extrarenal potassium metabolism. Last, the serum potassium concentration per se directly influences its own cellular uptake and this transport mechanism appears to be inhibited by uremia.

Central pontine myelinolysis following correction of hyponatremia: MRI diagnosis

A 37-year-old woman with hepatic failure developed a locked-in syndrome after correction of a severe symptomatic hyponatremia. Magnetic resonance imaging showed a lesion involving the basis pontis and extending into the midbrain, consistent with central pontine myelinolysis. In this patient the rate of correction of hyponatremia was within the range considered sure by several authors, but factors such as hepatic encephalopathy, a single generalized seizure and correction of hyponatremia in 42 h with a change in serum sodium concentration of 34 mmol/l were present, and they could have been etiologically relevant. This case, like other recent reports, suggests new views about the pathogenesis of cerebral demyelinating lesions in patients with hyponatremia.

Pelvic lymphadenectomy and transperineal interstitial implantation of IR 192 combined with external beam radiotherapy for bulky stage C prostatic carcinoma

From January 1983 until June 1987, 51 patients with locally advanced prostatic carcinoma (47 Stage C, 4 bulky B2) were treated at Mayo Clinic (33 patients) and at William Beaumont Hospital (18 patients) with (a) 5 Gy delivered pre-operatively in one fraction, (b) pelvic lymphadenectomy and (c) interstitial implantation of the prostate with Ir 192 seeds via a perineal template (the Martinez Universal Perineal Interstitial Template) to deliver 35 Gy, and (d) 30.6 Gy external beam therapy in 17 fractions to prostate only fields. Initial clinical response has been excellent. Local control, with a median follow-up of 45 months, has been 100% by clinical exam and 84.5% pathologically in the subset biopsied. Disease-free actuarial survival at 5 years is 89%. Major toxicity has been limited to the rectum, but a modification of the brachytherapy technique has reduced this sharply. We conclude that bulky Stage C prostatic carcinoma can be successfully treated by this aggressive combination of modalities with acceptable toxicity.

Biliary excretion and choleretic effect of cefmetazole in rats

The effect of cefmetazole, a broad-spectrum cephalosporin, on bile flow and composition in rats was studied. Intravenous injection of cefmetazole at doses ranging from 40 to 400 mumol/kg of body weight led to an increase in its biliary concentration and excretion rate, with a maximum at 30 min after injection. Excretion of cefmetazole into bile was associated with a marked choleresis. The magnitude of the increase in bile flow was dose dependent, with a maximal increase at a dose of 200 mumol/kg. Cefmetazole administration did not affect the secretion of bile acids or their osmotic activities, whereas the bile acid-independent bile flow increased by 49% at a dose of 200 mumol/kg. Cefmetazole administration at a dose of 200 mumol/kg significantly increased the biliary outputs of sodium, potassium, chloride, and bicarbonate (+36, +56, +28, and +31%, respectively) compared with outputs of controls. A linear relationship was observed between bile flow and cefmetazole excretion, 44 microliters of bile being produced per mumol of cefmetazole excreted into bile. Our results demonstrate that cefmetazole induces choleresis by stimulating bile acid-independent bile flow. This effect appears to be partly due to the osmotic properties of cefmetazole transported into bile.

Diagnostic value of quantitative cultures of bronchoalveolar lavage and telescoping plugged catheters in mechanically ventilated patients with bacterial pneumonia

We compared the diagnostic value of quantitative cultures of bronchoalveolar lavage (BAL) and telescoping plugged catheter (TPC) samples in 34 nonimmunocompromised, mechanically ventilated (MV) patients with suspected bacterial pneumonia. A control group of seven "noninfected" MV patients was also studied. In 92% of patients with bacterial pneumonia (32 of 34), simple endotracheal aspiration samples recovered one or more microorganisms. Both BAL and TPC samples cultured colony-forming units (cfu) greater than or equal to 10(3)/ml of one or more microorganisms in 56% (19 of 34) of patients. TPC and BAL culture results agreed on 88.5% (54 of 61) of the recovered microorganisms. Sterile TPC and BAL cultures agreed on 80% (4 of 5) of the cases. Microorganisms cultured from blood samples were also cultured from BAL and TPC specimens. Culture results from the two techniques completely disagreed in only one case (3%). In the control group, one TPC and two BAL cultures yielded microorganisms in cfu greater than or equal to 10(3)/ml. Specificities of BAL and TPC were 71 and 86%, respectively, whereas specificity of endotracheal aspiration was only 14%. Both the bacterial index obtained by TPC and BAL, as well as the quantitative cultures, correlated moderately well (r = 0.78 and 0.72, respectively, p less than 0.001 for both correlations). BAL and TPC results caused changes of antibiotic treatment in 11 of 23 survivors. Neither BAL nor TPC caused complications. Our results demonstrate that BAL and TPC diagnose bacterial pneumonia in MV patients with similar accuracy. Culture results from both techniques showed excellent qualitative and reasonable quantitative agreement.

Biocarbon ureterostomy device for urinary diversion. Multicenter clinical trial

The bioCarbon ureterostomy device is a stomal prosthesis for upper tract urinary diversion that has had preliminary successes in animal and human trials in Europe and Peru. Implantation of a pure carbon stomal prosthesis offers the potential advantages of high biocompatibility, lack of encrustation, and elimination of stomal stenosis which is frequently associated with cutaneous ureterostomy. Nine bioCarbon ureterostomy devices were implanted from August, 1984 through July, 1985. Although successful implantation was achieved in 2 patients, the complication rate was high. The bioCarbon ureterostomy device has potential as an alternative form of urinary diversion. However, significant problems need to be remedied before it can be recommended for routine clinical application.

Evaluation of culture techniques for identification of catheter-related infection in hemodialysis patients

A prospective study was conducted over eight months to evaluate the usefulness of two culture techniques using different catheter parts for detection of bacterial colonization or catheter-related bacteremia in patients with jugular or subclavian hemodialysis catheters. A combination of semiquantitative culture of the external surface and quantitative culture of the intraluminal surface of the intradermal catheter segment provided the best means of detecting catheter colonization. For detection of catheter-related bacteremia, this combination had 100% sensitivity and a positive predictive value similar to the actual rate of catheter-related bacteremia.