The effect of anticoagulant choice on apparent total antioxidant capacity using three different methods

We assessed total antioxidant capacity using three different methods, in plasma samples treated with either EDTA or heparin as anticoagulant, from 26 healthy subjects. Total antioxidant capacity was determined using an oxygen electrode (as the total peroxyl radical-trapping antioxidant parameter), by enhanced chemiluminescence, and by measurement of the antioxidant-mediated quenching of the absorbance of a radical cation. The choice of anticoagulant had a profound effect on antioxidant capacity with heparinized plasma giving consistently higher values than plasma anticoagulated with EDTA. Using the oxygen electrode the mean value was 786.5 +/- 171.5 mumol/L (heparin) compared to 681.4 +/- 160.4 mumol/L (EDTA, P < 0.01). The chemiluminescence technique gave a mean antioxidant capacity of 915.6 +/- 214.1 mumol/L in heparin samples and 714.4 +/- 195.4 mumol/L in EDTA samples (P < 0.0001). The absorbance quenching technique gave a mean value of 867.0 +/- 199.2 mumol/L (heparin) and 675.5 +/- 245.4 mumol/L (EDTA, P < 0.001). All methods tested showed comparable results for EDTA plasma, but the chemiluminescence technique gave higher apparent antioxidant capacity than either of the two techniques when heparin plasma was used. We suggest that either heparin is interacting to enhance antioxidant protection perhaps through release of superoxide dismutase, or the chelation of metal ions by EDTA is limiting the activity of antioxidant metalloenzymes. Consistency in the choice of anticoagulant is clearly extremely important.

Multi-generational carcinogenesis from diethylstilbestrol investigated by blastocyst transfers in mice

Previous studies have shown that a carcinogenic effect can be transmitted from female mice exposed prenatally to diethylstilbestrol (DES) to their female offspring. Furthermore, male mice exposed pre-natally to DES can transmit a carcinogenic effect to their offspring through their germ cells. To study how multi-generational carcinogenesis is transmitted through females exposed pre-natally to DES, the technique of blastocyst transfer was utilized. Blastocysts from strain CD-1 mice exposed pre-natally to vehicle were transferred to mice exposed pre-natally to DES. Among 143 offspring from these transfers, there were 10 ovarian adenomas and 10 uterine adenocarcinomas. Among 92 offspring from blastocyst transfers between mice exposed pre-natally to vehicle only, there was 1 ovarian adenoma and 1 uterine adenocarcinoma. Thus the pre-natal exposure of the host to DES produced a maternal environment which increased the incidence of ovarian and uterine tumors. The reverse type of transfer was also performed, in which blastocysts from female mice exposed pre-natally to DES were transferred into mice exposed to vehicle only pre-natally. Among 99 offspring derived from DES-exposed germ cells, 6 developed ovarian adenomas and 16 developed uterine adenocarcinomas. Thus DES also has a multi-generational effect transmitted through the blastocyst, which is consistent with fetal germ cell mutation from DES.

Decreased antioxidant status and increased lipid peroxidation in patients with septic shock and secondary organ dysfunction

OBJECTIVE

To determine antioxidant vitamin concentrations, lipid peroxidation, and an index of nitric oxide production in patients in the intensive care unit (ICU) with septic shock and relate the findings to the presence of secondary organ failure.

DESIGN

A prospective, observational study.

SETTING

A nine-bed ICU in a University teaching hospital.

PATIENTS

Sixteen consecutive patients with septic shock, defined as: a) clinical evidence of acute infection; b) hypo- or hyperthermia (< 35.6 degrees C or > 38.3 degrees C); c) tachypnea (> 20 breaths/min or being mechanically ventilated); d) tachycardia (> 90 beats/min); e) shock (systolic pressure < 90 mm Hg) or receiving inotropes. Fourteen patients also had secondary organ dysfunction.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Antioxidant vitamin concentrations were significantly lower in the patients than the reference range obtained from a comparable group of healthy controls. The mean plasma retinol (vitamin A) concentration was 26.5 +/- 19.3 micrograms/dL compared with 73.5 +/- 18.3 micrograms/dL in healthy subjects (p < .01). Additionally, 13 (81%) patients had retinol values below the lower limit of our reference range (< 37.0 micrograms/dL). Tocopherol (vitamin E) plasma concentrations were below the reference range in all patients (< 9.0 mg/L), with a mean value of 3.6 +/- 2.0 mg/L compared with 11.5 +/- 1.3 mg/L in healthy subjects (p < .001). Plasma beta carotene and lycopene concentrations were undetectable (< 15 micrograms/L) in eight (50%) patients, and below our reference range (< 101 micrograms/L and < 154 micrograms/L, respectively) in the remaining patients. In the five patients with three or more dysfunctional secondary organs, plasma thiobarbituric acid-reactive substances were significantly increased (p < .05), suggesting increased lipid peroxidation. Concentrations of thiobarbituric acid-reactive substances correlated negatively with both plasma retinol and plasma tocopherol (r2 = .42, p < .01 and r2 = .48, p < .005, respectively). In the five patients from whom we were able to collect urine, nitrite excretion was increased approximately 400-fold (p < .001).

CONCLUSIONS

These data indicate decreased antioxidant status in the face of enhanced free radical activity, and suggest potential therapeutic strategies involving antioxidant repletion.

Nitric oxide synthase activity is increased in patients with sepsis syndrome

1. We measured nitric oxide synthase activity in peripheral blood polymorphonuclear leucocytes from 10 patients with sepsis syndrome and 10 healthy subjects. 2. Synthase activity was significantly higher in patients with sepsis than in control subjects (1202 +/- 579 compared with 595 +/- 544 pmol of nitric oxide min-1 mg-1 of cell protein, P < 0.05). 3. Activity was greatest in those patients with the larger number of organ failures, although this failed to reach significance (1489 +/- 560 in patients with three or more organ failures and 843 +/- 404 pmol of nitric oxide min-1 mg-1 of cell protein in those with less than three, P = 0.11). 4. This study provides evidence for the role of overproduction of the vasodilator nitric oxide in sepsis syndrome.

Nitric oxide production by human peripheral blood polymorphonuclear leucocytes

1. We describe a rapid and reliable technique for the assessment of basal nitric oxide release in clinical situations, using peripheral blood polymorphonuclear leucocytes isolated by a single-step density gradient procedure. The assay is based on the quantitative conversion of oxyhaemoglobin to methaemoglobin by nitric oxide. We have further examined the ability of these cells to respond to various stimuli. 2. Basal (unstimulated) nitric oxide release occurred, which was augmented by superoxide dismutase. The mean value for healthy subjects was 283 +/- 96.7 pmol min-1 10(-6) cells. 3. Both phorbol myristate acetate and N-formyl-methionyl-leucylphenylalanine induced further release of nitric oxide, which was increased by preincubation with lipopolysaccharide, interleukin-6 and interferon-gamma. 4. Preincubation of cells with NG-monomethyl-L-arginine or L-canavanine sulphate inhibited nitric oxide production. 5. The procedure provides a valuable tool for monitoring nitric oxide up-regulation in clinical situations.

Reperfusion injury, antioxidants and hemodynamics during orthotopic liver transplantation

Endothelial injury occurs as a result of oxygen free radical production after ischemia and reperfusion of transplanted livers, causing hemodynamic disturbance. Patients with chronic liver disease generally have low levels of fat-soluble vitamins, which have important antioxidant roles. We therefore assessed circulating levels of the antioxidants vitamin A, vitamin E, beta-carotene and lycopene, indices of lipid peroxidation and hemodynamic changes during elective orthotopic liver transplantation in 12 patients. We found that initial antioxidant levels were severely depleted compared with healthy subjects, and in some patients carotene and lycopene levels were undetectable. Increased lipid peroxidation was also evident, as shown by thiobarbituric acid-reactive substances. On reperfusion of the liver graft, vitamin A and E levels fell (p < 0.01) and were associated with decreases in systemic vascular resistance (p < 0.02). These data show that patients undergoing liver transplant have lowered antioxidant defenses and evidence of free radical damage, which compound the additional insult of reperfusion injury. Antioxidant therapy in these patients before transplantation may ameliorate the effects of reperfusion.

Potentiation of triamcinolone-induced cleft palate in mice by maternal high dietary fat

This study investigated whether the current range in dietary fat levels, which has arisen partly in response to some major health concerns, would affect frequency of congenital anomalies if continued into the period of early pregnancy. The effect of 5.6%, or 48% of calories from fat in the maternal diet, was tested on pregnant strain CD-1 mice injected with triamcinolone in doses of 0.01 mg, 0.02 mg, 0.04 mg, or 0.06 mg per day on days 11 through 14 of gestation. Frequency of cleft palate increased with increasing doses of triamcinolone, with clefts of the palate being rare at the two lower doses. No clefts appeared without triamcinolone on either diet. In combination with triamcinolone treatment, 226 fetuses exposed to a maternal low fat diet had normal palates and 86 had cleft palates. With exposure to high fat, 186 fetuses had normal palates and 101 had cleft palates, which was a significant increase in clefting (p < 0.05). Also, the latter group showed a greater degree of retardation in palate development (p < 0.05). Thus both a greater frequency and a more severe form of clefting support the conclusion that high dietary fat potentiated the cleft palate-producing effects of triamcinolone in mice.

Pituitary tumors in mice exposed prenatally to diethylstilbestrol

Hyperprolactinemia and prolactinomas are among the abnormalities reported for women exposed prenatally to diethylstilbestrol (DES). To pursue this issue in an animal model replicating the other abnormalities of prenatal DES exposure, pituitary glands were studied in the offspring of CD-1 mice receiving an i.p. injection of 1 or 2 micrograms DES/g body weight during late pregnancy. Among 132 mice exposed prenatally to DES and then raised to terminal illness, there were 24 pituitary tumors compared to only 1 tumor among 64 controls. The tumors consisted predominantly of cells with an eccentric nucleus and cytoplasm characterized by an acidophilic core and basophilic rim. These cells were identified as lactotrophs on the basis of prolactin immunohistochemistry and by an expected variation in frequency relative to physiological states. Evaluation of ovaries from the same mice revealed a deficiency of corpora lutea and an elevated incidence of ovarian tumors. These findings are consistent with abnormal sex differentiation of the fetal hypothalamus being the cause of most adverse effects from prenatal DES exposure.

Correction of cellular zinc depletion by oral zinc supplementation in elderly subjects

Immune function declines with age, and has been implicated in the increased incidence of cancer and infections in the elderly. In this hospital, many elderly patients have evidence of zinc depletion. In the present study, we supplemented those elderly patients who had depressed polymorphonuclear cell (PMNC) zinc levels with 135 mg oral zinc sulphate for 4 weeks. Plasma and PMNC zinc increased markedly but the percentage of peripheral blood T-lymphocytes expressing the surface markers CD3, CD4 and CD8 were unchanged. Plasma concentrations of vitamins A and E also remained constant. This study confirms the 25-30% incidence of cellular zinc depletion in this patient population, and demonstrates that zinc concentrations can be brought back to within normal limits by oral zinc supplements, but with no effect on T-cell phenotypes.

Early diagnosis of ectopic arginine vasopressin secretion

We describe a patient who presented with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) 2 months before clinical evidence of bronchogenic malignancy. Because of the potential for the ectopic production of atrial natriuretic peptide (ANP) to mimic SIADH, both hormones were measured in this hyponatremic patient to seek a possible marker of tumor activity. A hypertonic saline infusion at presentation revealed excessive osmotically decoupled secretion of arginine vasopressin but a normal ANP response.

Early diagnosis of ectopic arginine vasopressin secretion

We describe a patient who presented with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) 2 months before clinical evidence of bronchogenic malignancy. Because of the potential for the ectopic production of atrial natriuretic peptide (ANP) to mimic SIADH, both hormones were measured in this hyponatremic patient to seek a possible marker of tumor activity. A hypertonic saline infusion at presentation revealed excessive osmotically decoupled secretion of arginine vasopressin but a normal ANP response.

Evidence of hypothalamic involvement in the mechanism of transplacental carcinogenesis by diethylstilbestrol

Disruption of hypothalamic sex differentiation in the fetus is one hypothesis to explain female reproductive system anomalies and cancer arising from prenatal exposure to diethylstilbestrol (DES). To further test this hypothesis, breeding performance and behavior were monitored in a colony of mice exposed prenatally to DES, using a schedule previously shown to produce anomalies and cancer of the female reproductive system. Fertility decreased with age more rapidly in DES-exposed females than in control females. DES-exposed females were less accepting of the male than control females. These observations support the hypothesis of abnormal hypothalamic sex differentiation as a basic mechanism in DES transplacental carcinogenesis.

Vitamin C depletion and pressure sores in elderly patients with femoral neck fracture

OBJECTIVE

To evaluate the contribution of specific nutritional deficiencies (as indicated by zinc; vitamin A, C, and E; albumin; and haemoglobin concentrations) to the risk of pressure sores.

DESIGN

Observational cohort study.

SETTING

St James's University Hospital, Leeds.

SUBJECTS

21 elderly patients presenting consecutively to the orthopaedic unit with femoral neck fracture.

MAIN OUTCOME MEASURE

Full thickness epidermal break over a pressure bearing surface.

RESULTS

10 patients (48%) developed a pressure sore during their hospital stay. Indices of zinc status and concentrations of albumin, haemoglobin, and vitamins A and E were similar in patients who developed a pressure sore and those who did not. Mean leucocyte vitamin C concentration, however, was 6.3 (SD 2.2) micrograms/10(8) cells in patients who developed a pressure sore as compared with 12.8 (4.6) micrograms/10(8) cells in patients who did not.

CONCLUSIONS

Low concentrations of leucocyte vitamin C appear to be associated with subsequent development of pressure sores in elderly patients with femoral neck fractures.

Symptomatic zinc deficiency in experimental zinc deprivation

An evaluation of indices of poor zinc status was undertaken in five male subjects in whom dietary zinc intake was reduced from 85 mumol d-1 in an initial phase of the study to 14 mumol d-1. One of the subjects developed features consistent with zinc deficiency after receiving the low zinc diet for 12 days. These features included retroauricular acneform macullo-papular lesions on the face, neck, and shoulders and reductions in plasma zinc, red blood cell zinc, neutrophil zinc and plasma alkaline phosphatase activity. Alcohol induced hepatitis, which was suspected in this subject, may have caused a predisposition to altered zinc metabolism and possible zinc deficiency which was exacerbated by subsequent zinc deprivation. The report supports the value of neutrophil zinc concentration as an indicator of poor zinc status.

No effect of adult dietary fat on tumors induced prenatally by diethylstilbestrol

Strain CD-1 female mice exposed prenatally to diethylstilbestrol (DES) or vehicle were placed on semipurified diets containing 2.6%, 10%, 20%, or 29% fat by weight at four weeks of age. These mice were used as a breeding colony for a few weeks and then maintained to terminal illness on the semipurified diets. Females exposed prenatally to DES developed mammary tumors, pituitary tumors, and glandular tumors of the reproductive tract. There was no significant difference in tumor frequency between low- and high-fat dietary groups. Fewer tumors appeared in the vehicle-exposed mice, as expected, and their frequency did not differ between the dietary groups. Pregnancy reduced tumor frequency in DES-exposed mice, but the incidence of pregnancy was not significantly different between low- and high-fat dietary groups. In the adult the failure of a high-fat diet to increase the frequency of reproductive system tumors induced prenatally is in marked contrast to the effectiveness of high-fat diets in promoting mammary tumors induced by carcinogens given to rats postnatally. This difference is critical in the interpretation of epidemiological studies. The relationship of dietary fat to reproductive system cancer in human populations was reviewed in comparison with these two animal models. The epidemiological literature was found to be more consistent with the animal model, showing high sensitivity to dietary fat prenatally but no significant sensitivity at the adult stage of life.

Case report: hepatobronchial fistula complicating amoebiasis, treated by percutaneous catheter drainage

We report the case of a 41-year-old man who presented with hepatic amoebiasis 18 months after visiting the Far East. His progress was initially complicated by a bronchohepatic fistula which was further complicated by secondary bacterial infection. The fistula persisted and only resolved following percutaneous catheter drainage, thereby avoiding open surgery.

Effect of fasting, self-selected and isocaloric glucose and fat meals and intravenous feeding on plasma zinc concentrations

This study investigated the effect of fasting, self-selected meals and isocaloric oral glucose and fat meals and intravenous (i.v.) feeding on plasma zinc concentrations in men. Plasma zinc remained stable when volunteers fasted all day, but self-selected meals and 600 kCal of dextrose or fat emulsion caused significantly reduced plasma zinc concentrations [mean (SD) 12.1 (1.4), 12.3 (0.6) and 12.2 (0.7) mumol/L at 1400 h, respectively, compared with a fasting level of 13.9 (1.6) mumol/L at 0800 h, P less than 0.05]. In patients undergoing intravenous hyperalimentation, plasma zinc decreased from 12.0 (1.4) mumol/L at 0800 h to 10.0 (1.1) mumol/L at 1400 h [mean (SD), P less than 0.01]. These data show that both enteral and i.v. feeding cause a decline in plasma zinc and that glucose alone is not responsible for this post-prandial fall since ingestion of isocaloric amounts of glucose or fat have a similar effect.

Evidence of cellular zinc depletion in hospitalized but not in healthy elderly subjects

Cellular immune function declines with age and is implicated in the increased incidence of cancer, and morbidity and mortality associated with infections in elderly people. Elderly people are at risk of nutritional depletion, including of zinc, and zinc is known to influence immunity. The present study assessed zinc status in both healthy elderly subjects and elderly inpatients. Polymorphonuclear-cell zinc was decreased in the hospitalized subjects and 27% had values below the reference range for healthy elderly and young subjects. Since PMNC zinc is decreased in experimental zinc depletion and correlates with muscle zinc, we suggest that 27% of the patients studied may be zinc depleted and may benefit from zinc supplementation.

Venepuncture for calcium assays: should we still avoid tourniquet?

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Monocyte zinc and in vitro prostaglandin E2 and interleukin-1 beta production by cultured peripheral blood monocytes in patients with Crohn's disease

This study investigated the relationship between zinc status and prostaglandin E2 and interleukin-1 beta production by cultured monocytes in patients with Crohn's disease. Monocyte zinc was significantly decreased in both 12 inpatients and 22 outpatients compared with controls (P less than 0.001) but lymphocyte and polymorphonuclear cell zinc were normal. When cultured monocytes from 10 outpatients with Crohn's disease were stimulated with lipopolysaccharide, prostaglandin E2 production increased markedly, coupled with a fall in monocyte zinc. In matched controls, prostaglandin E2 production was significantly less and monocyte zinc remained stable. No difference in interleukin-1 release was noted between patients and controls. The addition of prednisolone to cell cultures suppressed prostaglandin E2, interleukin-1 synthesis, and monocyte zinc did not change. Zinc chloride augmented prostaglandin E2 production in patients, but not controls, and interleukin-1 remained stable. These results demonstrate a link between low monocyte zinc concentration and excessive prostaglandin production in patients with Crohn's disease.

The effects of acute infection on indices of zinc status

Various indices of zinc status were assessed in 12 patients with acute urinary tract or chest infections on Day 1 and Day 7 of the infection. Leucocyte counts were raised on Day 1 but had returned to near normal by Day 7. Plasma zinc was decreased on Day 1 in conjunction with depressed plasma albumin concentrations (r = 0.71, p < 0.001) but both had returned to normal by Day 7. Mononuclear cell zinc was raised in all patients on Day 1 compared to Day 7 and control values, but polymorphonuclear cell zinc remained unchanged. However, polymorphonuclear cell alkaline phosphatase activity was grossly increased on Day 1 and correlated with leucocyte count (r = 0.61, p < 0.01). Plasma alkaline phosphatase activity was variable. These results indicate that in patients with infections measurement of plasma mononuclear cell zinc concentration and alkaline phosphatase activity are misleading indicators of zinc status. Polymorphonuclear cell zinc is unaffected by leucocytosis, inflammation and stress and may therefore provide a more reliable index of zinc status in such patients.

Cellular and muscle zinc in surgical patients with and without gastrointestinal cancer

1. The zinc status of surgical patients with and without gastrointestinal cancer was studied. 2. Plasma zinc was lowest in patients with cancer concurrent with depressed plasma albumin concentrations. 3. Polymorphonuclear cell zinc was decreased in both patient groups and correlated strongly with abdominal muscle zinc (r = 0.89, P less than 0.001). 4. Mononuclear cell and total leucocyte zinc were similar to control values in both groups of patients. Total leucocyte, but not mononuclear cell, zinc correlated weakly with muscle zinc (r = 0.48, P less than 0.05). 5. The results suggest that polymorphonuclear cell zinc may be better than leucocyte zinc in assessing zinc status and that some surgical patients may be zinc-depleted. The presence of gastrointestinal cancer did not influence the zinc status.

Relation between zinc status and hepatic functional reserve in patients with liver disease

Patients with liver disease may be at risk of zinc depletion. We measured polymorphonuclear cell, mononuclear cell, plasma, and erythrocyte zinc values, and erythrocyte carbonic anhydrase activity to assess zinc status in 17 patients with non-alcoholic liver disease (primary biliary cirrhosis and chronic active hepatitis) and 13 patients with alcoholic liver disease. The plasma zinc concentration was reduced in both patient groups and correlated strongly with the plasma albumin concentration. The mean polymorphonuclear cell zinc value in both groups was similar to that of controls but when results were combined and grouped according to hepatic functional reserve, patients with more severe liver damage (grade C) had a lower polymorphonuclear cell zinc value (mean (SD) 0.86 (0.24) nmol/mg protein) than patients with grade A (1.44 (0.43) nmol/mg protein, p less than 0.01) or grade B liver damage (1.08 (0.30) nmol/mg protein, p less than 0.05), or control subjects (1.26 (0.28) nmol/mg protein, p less than 0.001). The polymorphonuclear cell zinc value did not correlate with other indices of zinc status. The mononuclear cell zinc value was normal in all patients and was unrelated to hepatic damage. The erythrocyte zinc value and carbonic anhydrase activity were raised in alcoholic patients only. Since the polymorphonuclear cell zinc concentration is low in human experimental zinc deficiency and also correlates with tissue zinc, we suggest that our results provide evidence of progressive leucocyte zinc depletion in patients with liver disease.

Tumors in female offspring of control and diethylstilbestrol-exposed mice fed high-fat diets

Strong correlations have been established internationally between female reproductive system cancer rates and dietary fat. To test the hypothesis that the prenatal period is a critical time for exposure to high dietary fat, we placed adult female strain CD-1 mice with or without prenatal exposure to diethylstilbestrol (DES) on diets with low or high levels of fat and mated them. After delivery of the litters, these mice were given the commercial diet on which they had been raised. Their female offspring were raised on this commercial diet until terminal illness occurred. Of the 47 offspring of control mice on low-fat diets, only five had reproductive system tumors, whereas tumors developed in 39 of 78 offspring of mice on high-fat diets. For DES-exposed mice, tumors developed in 18 of 64 offspring of mice on low-fat diets and 38 of 70 offspring of mice on high-fat diets. Nine mice with metastatic mammary tumors and seven with pituitary tumors were offspring of mice on high-fat diets.