Influence of diltiazem on renal function and rejection in renal allograft recipients receiving triple-drug immunosuppression: a randomized, double-blind, placebo-controlled study

In a prospective, randomized and placebo-controlled study we evaluated the influence of treatment with the calcium-channel blocker diltiazem on the course and results of cadaveric kidney transplantation in 39 graft recipients. The grafts were reperfused with Euro-Collins solution containing diltiazem 20 mg/l. All recipients except those in chronic treatment with a calcium-channel blocker received preoperatively a bolus of diltiazem or placebo 0.3 mg/kg and in all an infusion of diltiazem or placebo 3 mg/kg/24 h was started preoperatively. After that, diltiazem or placebo was given orally for 3 months. Donors were not treated. Immunosuppressive therapy consisted of prednisone, azathioprine and CsA. There were no significant differences between the groups concerning donor or recipient characteristics, HLA-mismatching, and ischaemic time. Thrombosis leading to graft loss occurred in 3 recipients (diltiazem:2, placebo:1) and one graft was lost due to septicaemia (diltiazem). For the remaining 35 grafts no beneficial effect of treatment with diltiazem was found for the rate of delayed graft function, the rate of rejections, time to first rejection, whole blood CsA concentration, or graft function. The CsA dose needed to reach target whole blood concentration was significantly less in the diltiazem group. In conclusion, our results do not indicate any beneficial effects of treatment with diltiazem in cadaveric kidney transplantation, except a reduction of costs because of a significant reduction of the CsA dosage.

[Substance analytic studies of the effectiveness of laser coagulation in diabetic retinopathy]

An order to optimize photocoagulation in diabetic retinopathy, it is necessary to have objective criteria concerning substance-specific fundus changes like blood, melanin, xanthophyl, cytochrome aa3, and light scattering. By means of fundus reflectometry macular reflectance spectra can be measured and are different in normals and in diabetics before or after treatment. If logarithmic difference spectra are used only pathological alterations or changes caused by the coagulation are demonstrable. These difference spectra can be approximated by a linear model function containing the extinction spectra of the substances mentioned above and a term for light scattering. Spectra deconvolution delivers coefficients, describing differences in the substance concentrations between diabetics before and after treatment and age-matched normals. When we examined these coefficients, we found that neither their behavior in diabetic retinopathy nor their reaction to photocoagulation is unique. Thus, it might be possible to obtain references to patient-specific adapted coagulation by deconvolution of the macular reflectance spectra measured before treatment. Classification of the patients in specific types of reaction, according to the shape of the logarithmic difference spectra or the results of the spectra deconvolution, could be a step in deciding on the success of the therapy on a case-to-case basis.

Early cytokine response to multiple injury

Serial measurements of the inflammatory cytokines interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF alpha) were made in four patients with multiple injuries to characterize secretion patterns and to relate them to severity of injury and degree of haemorrhage. IL-6 and TNF alpha were assayed using a sandwich ELISA. Injury scores varied from 9 to 50, and transfusion requirements varied from 7 to 14 units. All patients showed an increase in IL-6 but only one a rise in TNF alpha. There was no consistent pattern in the elevation of IL-6 and there was no relation between cytokine levels, severity of injury, transfusion requirement or ultimate outcome. From this preliminary study it would seem that measurement of IL-6 and TNF alpha is not of value in directing therapeutic decisions or as a predictor of outcome.

Drug-related lupus in a patient with rheumatoid arthritis under sulfasalazine treatment

The induction of lupus-like syndromes with the appearance of single-stranded DNA antibodies is a well-known complication of drug therapy. In this report we present a patient with an erosive seropositive rheumatoid arthritis developing the clinical and serological features of systemic lupus erythematosus including the occurrence of double-stranded DNA antibodies under sulfasalazine treatment.

Intracellular persistence of chlamydial major outer-membrane protein, lipopolysaccharide and ribosomal RNA after non-productive infection of human monocytes with Chlamydia trachomatis serovar K

The replication of Chlamydia trachomatis serovar K was studied in human peripheral blood monocytes (PBMo). The intracellular fate of the bacteria was examined by determining the presence of chlamydial major outer-membrane protein (MOMP), lipopolysaccharide (LPS) and ribosomal RNA (rRNA). In-vitro infection of PBMo with C. trachomatis serovar K was not productive. However, chlamydial MOMP antigen, demonstrated by immunofluorescence, was present in PBMo for up to 14 days. Infected monocytes also contained chlamydial rRNA, measured by in-vitro hybridisation, and LPS, measured by enzyme immunoassay, for up to 14 days. These data are compatible with the hypothesis that the infection of PBMo with C. trachomatis may play a role in the systemic distribution of chlamydial antigens, leading to systemic manifestations of urogenital chlamydial infection.

The effects of physical abuse on children's social relationships

Social behavior and peer status of 87 physically abused 8-12-year-old urban children were compared with those of 87 case-matched nonmaltreated classmates. Peer nominations and peer ratings were collected in classrooms, social networks were assessed by child interview, family variables were assessed by interviewing mothers, and behavior problems were rated by parents and teachers. Significant findings were that abused children had lower peer status and less positive reciprocity with peers chosen as friends; they were rated by peers as more aggressive and less cooperative and by parents and teachers as more disturbed; and their social networks showed more insularity, atypicality, and negativity. Social behavior as perceived by peers accounted for a significant portion of the variance in social status; global disturbance measures did not add to this association. Results are discussed in terms of a context of family violence in the development of social maladjustment.

Age differences in cognitive performance in later life: relationships to self-reported health and activity life style

The predictive relationships among individual differences in self-reported physical health and activity life style and performance on an array of information processing and intellectual ability measures were examined. A sample of 484 men and women aged 55 to 86 years completed a battery of cognitive tasks measuring verbal processing time, working memory, vocabulary, verbal fluency, world knowledge, word recall, and text recall. Hierarchical regression was used to predict performance on these tasks from measures of self-reported physical health, alcohol and tobacco use, and level of participation in everyday activities. The results indicated: (a) individual differences in self-reported health and activity predicted performance on multiple cognitive measures; (b) self-reported health was more predictive of processing resource variables than knowledge-based abilities; (c) interaction effects indicated that participation in cognitively demanding activities was more highly related to performance on some measures for older adults than for middle-aged adults; and (d) age-related differences in performance on multiple measures were attenuated by partialing individual differences in self-reported health and activity.

Disequilibrium of multiple DNA markers on the human Y chromosome

We characterized four DNA polymorphisms on the Y chromosomes of 123 males from five Caucasian populations. Three markers on the male specific portion of the chromosome varied appreciably in frequency among the populations. When combined, these markers define a limited number of haplotypes compared with the maximum expected on the basis of random association. The associations found in the five groups are qualitatively similar and are thus considered to be relatively stable on an evolutionary time-scale and possibly to predate the divergence of Caucasian populations. However, the haplotype frequencies varied markedly among populations, even between weakly isolated areas such as northern vs. southern Sardinia. This may indicate rapid progression towards fixation of alternative types of Y chromosomes. We also report data suggesting that the same associations no longer hold when examining a marker as close as 275 bp from the boundary of the pseudoautosomal region on the Y chromosome.

Spectrometric investigations in ocular hypertension and early stages of primary open angle glaucoma and of low tension glaucoma--multisubstance analysis

The approximation of logarithmic difference spectra between the reflectance of the normal fundus and the fundus reflectance in different stages of glaucoma is demonstrated by a model. The influences of fundus pigments like oxihemoglobin, melanin, xanthophyll and rhodopsin as well as the intensity and the exponent of the scattered light are optimized. Glaucomatous alterations in the extinction of these pigments and of the scattering parameters are different in the macula, in the papillo-macular bundle and in the parapapillary region temporal to the optic disc. A lack of oxihemoglobin only in the papillo-macular bundle in first relative losses in the visual field function points to a damaged microcirculation in early POAG. In progressive glaucoma the extinction spectrum of xanthophyll is detectable in the papillo-macular bundle. A decreased intensity of the scattered light and an altered scattering exponent are suggestive of a damage in the nerve fiber layer at early stages of glaucoma.

[Arthritic changes in small and large joints in digital and conventional x-ray images]

In order to evaluate the suitability of digital radiography for the diagnosis of skeletal abnormalities, inflammatory joint changes were used to test this technique. Early erosive changes, fine irregularities and marginal lamellar abnormalities demand a high degree of resolution from the imaging method. 6 observers studied images of the hand of 67 and of the foot of 19 patients. Joint changes were staged according to the scheme proposed by Larsen; in this study the early stages predominated. With similar techniques there were no significant differences between the digital and conventional techniques. Images of 39 large joints (knee, shoulder, elbow, ankle) were compared only subjectively since even minor differences in projection were able to obscure some erosions. However, in this case also both techniques appear to be of similar value.

Dentistry for children. How it is done in British Columbia, Canada. A report of an exchange-student from Germany

In Vancouver, there is a Children's Hospital unique for its kind: Various paediatric departments are covered under one roof. Matthias Hammer, a dental student from Germany, describes their cooperation and the import of the dental department.

Chlamydial rRNA in the joints of patients with Chlamydia-induced arthritis and undifferentiated arthritis

Synovial fluid and synovial membrane specimens of 11 patients with Chlamydia-induced arthritis (CIA), 24 patients with undifferentiated arthritis (UndA), 4 patients with post-enteritic reactive arthritis, 3 patients with Lyme arthritis and 9 patients with rheumatoid arthritis were investigated for the presence of Chlamydia trachomatis (C. trachomatis). A single stranded DNA-probe was used for nucleic acid hybridization with ribosomal RNA (rRNA) from C. trachomatis. In 4 patients (CIA = 1, UndA = 3) chlamydial rRNA was found in the synovial fluid. In one additional patient (CIA) the specimen of a synovial membrane biopsy was positive for chlamydial rRNA. The detection of intra-articular chlamydial rRNA is discussed as an indicator for the presence of viable Chlamydiae in inflamed joints.

Neurosecretory cells in the honeybee brain and suboesophageal ganglion show FMRFamide-like immunoreactivity

Immunocytochemical analysis of the brain and suboesophageal ganglion of the honeybee Apis mellifera L. was combined with Lucifer Yellow backfilling from the corpora cardiaca and intracellular staining of single neurons. It is shown that more than one third of the cells that display FMRFamide-like immunoreactivity (F-LI) project to the corpora cardiaca, suggesting they are neurosecretory. Among the ca. 120 median neurosecretory cells (MNCs) in the pars intercerebralis about 32 show F-LI. The number of immunoreactive MNCs is highly variable and may depend on age and/or diet. Seven of at least 40 lateral neurosecretory cells display F-LI. They project through the brain via the medial branch of the bipartite nervus corporis cardiaci II. In the suboesophageal ganglion three types of immunoreactive neurosecretory cells were identified. Together with the median and the lateral neurosecretory cells in the brain these cells project through a single pair of nerves into the corpora cardiaca suggesting that the nervus corporis cardiaci (NCC) of the honeybee is a fusion of NCC I, II, and III described in other insects.

Activation of CD16+ effector cells by rheumatoid factor complex. Role of natural killer cells in rheumatoid arthritis

The role of natural killer (NK) cells in rheumatoid arthritis (RA) remains unclear. A pathogenetic function of rheumatoid factors (RF) also has not been defined. In the present studies, natural killer (NK) cells were examined as a model for FC gamma receptor type III-positive (FC gamma RIII+) cells, with regard to their interaction with RF. NK cell antigen CD16 (FC gamma RIII) and CD56 expression and functional NK and antibody-dependent cell-mediated cytotoxicity (ADCC) activity were compared in peripheral blood lymphocytes and autologous synovial fluid lymphocytes (SFL) of RA patients. Peripheral blood lymphocytes and SFL showed normal CD56 expression. In contrast, both the frequency and the density of CD16 antigen were decreased in SFL. Furthermore, diminished NK cytotoxicity and a significant decrease in ADCC were observed in SF NK cells. In subsequent in vitro studies with normal fresh NK cells, it was demonstrated that IgG-containing RF complexes from RA patients induced a modulation of FC gamma RIII structure from the NK cell surface, a decrease in NK activity, and a complete loss of ADCC. When purified RF was incubated with NK-enriched cell lines from RA patients, increased transcription and subsequent production of interferon-gamma and tumor necrosis factor alpha were observed. These data suggest a direct involvement of RF complexes in the pathogenetic process of chronic inflammation in RA.

Yersinia enterocolitica in the synovial membrane of patients with Yersinia-induced arthritis

Using a monospecific rabbit antibody against Yersinia enterocolitica outer membrane protein 1, we examined synovial biopsy specimens from 7 patients with Yersinia-induced arthritis. Yersinia were demonstrated in the synovial membrane by indirect immunofluorescence in 4 patients with Yersinia-induced arthritis, but not in 6 control patients with Salmonella-induced arthritis or with rheumatoid arthritis. These findings suggest the persistence of Yersinia in the joints of patients with Yersinia-induced arthritis.

[Yersinia-induced arthritis: new knowledge of pathogenesis, diagnosis and therapy]

Yersinia infections have been identified in rising incidence as the cause of acute or subacute intestinal or extraintestinal diseases in the past two decades. Immunopathological manifestations of Yersinia infections, e.g. Yersinia-induced arthritis, have evoked special interest among clinicians and microbiologists. Beneath epidemiological and clinical characteristics this review focuses on recent progress in pathogenesis and serological and immunohistological diagnosis of Yersiniosis. Possible consequences for newly therapeutical approaches in chronic Yersinia-induced arthritis and spondarthritis were discussed.

[Nosologic concept and new developments in the etiopathogenesis of reactive arthritis]

Reactive inflammatory arthritis is caused by extraarticular infection with different arthritogenic microorganisms. The causative bacteria can not be cultured from synovial specimens, but bacterial antigens have been demonstrated in cells of synovial fluid and synovial membrane, respectively. Thus, latent intraarticular infection may be the cause of reactive arthritis. A model of the etiopathogenesis of reactive arthritis is described on the basis of recent immunological and microbiological findings.

[Activation of Fc gamma receptor (CD16) positive natural killer cells by rheumatoid factors in rheumatoid arthritis]

Fc gamma-receptor-(CD16-)positive natural killer (NK) cells are activated by rheumatoid factor in the synovial fluid of patients with rheumatoid arthritis. This activation induces modulation of the CD16 molecule and release of IFN gamma and TNF alpha by NK cells.

Multiple sources of P3b associated with different types of information

This experiment investigated how the P3a, P3b, and Slow Wave components of the event-related brain potential (ERP) respond to manipulations of the nature, timing, and extent of information delivery. There were two experiments in which the total amount of task information was distributed between pairs of successive stimuli (S1 and S2) within each trail. The task was to predict the relation between S1 and S2. In Experiment 1, the S1 could resolve no, partial, or all uncertainty with respect to the prediction outcome (correct or incorrect). Each S1 delivered three types of information: 1) outcome information--which resolved the subjects' uncertainty about the correctness of their prediction; 2) procedural information--which resolved uncertainty about how much outcome information would be delivered by S1; and 3) memory information--the identity of S1, which had to be stored for subsequent comparison with S2. In Experiment 2, the activity of these components was contrasted in two conditions in which the S1 delivered either memory information alone or both memory and procedural information. P3a and Slow Wave were sensitive only to outcome information. P3b was sensitive to all three types of information, and its scalp topography varied as a function of the type of information. The topographic variations indicate that P3b is not a unitary phenomenon but rather is a composite of activity arising from multiple intracranial sources of bioelectric activity.

Alcohol consumption and pain phobia: toward a unifying theory of alcoholism

An attempt is made to contribute toward a unifying theory of alcoholism with the concept of "pain phobia" as its central factor. A brief theoretical exposition of pain phobia is offered and results of an empirical study are presented which lend considerable support to the position that pain phobia may be a central factor underlying alcoholism. The research utilizes the Pain Phobia Scale (PPS) as the measure of pain phobia and finds that pain phobia is present to a significantly greater degree in problem drinkers than a norm group and that pain phobia also discriminates non-problem drinkers in the degree of their consumption of alcohol. Suggestions are made for how the concept of pain phobia and the PPS can be useful in the treatment and prevention of alcoholism. The possible relationship between pain phobia and all addictions is also considered.

Serotonin acts in the synaptic region of sensory neurons in Aplysia to enhance transmitter release

An important mechanism that contributes to sensitization in Aplysia is heterosynaptic facilitation of the synaptic connections between sensory neurons (SNs) and motor neurons (MNs). Heterosynaptic facilitation, in turn, is associated with broadening of the spike in the SN. Spike broadening is readily observed in recordings from somata of SNs, and from growth cones of SNs in culture, but broadening in synaptic terminals has only been inferred. Intracellular recordings were made from somata of SNs and from somata of follower MNs. Additional recordings were made from the axons of SNs as they enter the neuropil in the pedal ganglion. Serotonin (5-HT) broadened action potentials in axons of SNs and enhanced excitatory postsynaptic potentials (EPSPs) in the MNs, even after the axons of SNs were surgically separated from their somata. These results indicate that both heterosynaptic facilitation and spike broadening in the axon are due to the local action of 5-HT and can occur independently of modulation of membrane properties in the soma.

[Detection of endotoxin in synovial tissue of patients with inflammatory-rheumatic diseases]

The etiology of inflammatory rheumatic diseases is unknown. The hypothesis, that bacteriae may play a part in the induction of a rheumatic synovialitis is further substantiated by the detection of Endotoxin (Lipid A) in the synovial membranes of five of eleven patients with early synovitis (disease duration shorter than 6 months) by using anti Lipid A monoclonal antibodies. Endotoxin (Lipid A) is a component of gram-negative bacteriae and Chlamydiae. It is a potent immunogen, and could be the link between infection of the gut or the urogenital system and the rheumatic synovialitis.

Gastritis and bacterial colonization of the gastric mucosa in adolescents

Among 256 examined gastric biopsies from 200 adolescents, inflammatory changes were found strikingly often: 44.5% showed chronic superficial gastritis without atrophic processes. However, the percentage of biopsies of normal mucosa was substantially higher than that of a compared series of biopsies not selected according to age of the patients. According to our findings in adolescents, the interstitial stroma of normal gastric mucosa in the antrum, as well as in the corpus, was absolutely free of round cells. Bacterial colonization with Campylobacter-like organisms (CLO) occurred almost as frequently as in the series not selected according to age. Consequently, the biopsy material of adolescents substantially more often featured normal mucosa with bacterial colonization, mostly of the minimal focal variety, than did the compared series. Colonization with CLO apparently takes place at an early age, and may exacerbate into a massive colonization.

Hypovolemic stimuli and vasopressin secretion in man

Different non-hypotensive hypovolemic stimuli were applied to 21 healthy and 20 uremic dialysis patients. The purpose was to study the effect on plasma arginine-vasopressin concentration, using orthostasis as a reference model. Orthostasis increased the plasma AVP level in healthy subjects as well as in uremic dialysis patients. In healthy subjects plasma AVP increased both when they were normohydrated and after they had been water-depleted. Lower body negative pressure (LBNP, -40 mmHg) was applied to 11 healthy males to induce a central blood volume decrease, equal to that induced by orthostasis. The plasma AVP increased in two subjects only who became hypotensive during the investigations. Ten hemodialysis patients were volume-depleted by isolated ultrafiltration. A flow directed Swan-Ganz catheter was used to measure the central intravascular pressures. Pulmonary capillary wedge pressure was reduced to normal or subnormal values during 1-2 h of ultrafiltration, without any significant changes in plasma AVP. Plasma AVP increased only in 2 patients, who became hypotensive during the investigations. Thus, of the present non-hypotensive volume stimuli only orthostasis was able to stimulate AVP secretion. Equal or even greater reductions in central blood volumes by other stimuli had no effect on AVP secretion. The results demonstrate that isolated stimulation of low-pressure volume receptors has no effect on the secretion of AVP in humans.

[Determination of endotoxin in inflammatory rheumatic diseases--the effect of nonsteroidal anti-inflammatory agents on intestinal permeability]

We measured the amount of plasma endotoxin in 95 patients with inflammatory rheumatic diseases (42 with ankylosing spondylitis; 12 with possible ankylosing spondylitis; 41 with rheumatoid arthritis) and in 16 patients with Crohn's disease with a quantitative Limulus assay. Significantly increased mean values were found in inflammatory rheumatic diseases and in Crohn's disease. Between 31% and 50% of the patients had endotoxin values higher than 10 pg/ml--none of the controls had such values. Patients on regular treatment with NSAIDS had higher amounts of endotoxin again. From our results we discuss an intestinal involvement in inflammatory rheumatic diseases. An inflammation of the gut with an increased permeability seems to be responsible for the raised plasma endotoxin levels compared to healthy controls. NSAIDs probably contribute to the increased permeability of the gut.

Hypouricemia and urate excretion in small cell lung carcinoma patients with syndrome of inappropriate antidiuresis

Urate concentrations in serum and renal urate clearance were prospectively evaluated in patients with small cell lung cancer (SCLC). Serum urate and renal urate clearance were measured before and during cytostatic treatment until disease progression (PD) in 12 patients with the syndrome of inappropriate antidiuresis (SIAD) and in 8 patients without. Hypouricemia occurred in 4 SIAD patients before treatment and also when tumor regression was obtained. Two normouricemic SIAD patients developed hypouricemia when PD occurred. No patient without SIAD experienced hypouricemia. Serum urate in patients with SIAD was lower than in those without SIAD before cytostatic treatment but not 3 months after the treatment. Hypouricemic patients had higher urate clearance than normouricemic and it remained higher even after tumor regression. Serum urate was invalid as marker of tumor regression or relapse. SIAD patients have higher glomerular filtration rates than patients without SIAD, which may influence the renal excretion of cytostatic drugs.

Molecular evidence for the rapid propagation of mouse t haplotypes from a single, recent, ancestral chromosome

Mouse t haplotypes are variant forms of chromosome 17 that exist at high frequencies in worldwide populations of two species of commensal mice. To determine both the relationship of t haplotypes to each other and the species within which they exist, 35 representative t haplotypes were analyzed by means of 10 independent molecular probes, including five DNA clones and five polypeptide spots identified by means of two-dimensional gel electrophoresis. All of the tested haplotypes were found to share restriction fragments and polypeptide spots that are absent in mice carrying wild-type forms of chromosome 17. This observation provides the first direct evidence that all of the known t haplotypes are descendents of a single ancestral chromosome. The absence of variation among t haplotypes could mean that this ancestral chromosome existed relatively recently, in which case it would be necessary to postulate introgressions of t haplotypes across species lines to explain their presence in both Mus domesticus and M. musculus. Alternatively, it is possible that the ancestral chromosome existed prior to the split between M. domesticus and M. musculus and that, by chance, our probes fail to detect polymorphisms that exist among the t haplotypes. A further result of our analysis is the characterization of a partial t haplotype in a wild population of Israeli mice.

Uveitis and arthritis induced by systemic injection of streptococcal cell walls

A single injection of an aqueous suspension of group A streptococcal peptidoglycan-polysaccharide complexes (PG-PS) when injected intraperitoneally into Lewis rats induced a self-limiting bilateral uveitis with associated perpetuating polyarthritis. The uveitis was characterized clinically during the first 72 h by iritis and fibrin deposition. Acutely, there was infiltration of polymorphonuclear cells. The symptoms gradually subsided, and at the close of the experiment eyes were normally clinically and histologically. In contrast, perpetuating inflammation and severe tissue injury developed in the limb. Using an enzyme immunoassay with specificity for the group A streptococcal polysaccharide, the levels of PG-PS in tissues of animals that were killed 1 to 7 days post-injection were measured. The relative amounts of antigen in eye:limb:liver of PG-PS injected animals were 1:9:170. The differences in the amounts of antigen detected in the eye and limb may help explain the development of the acute uveitis in contrast to the perpetuating polyarthritis observed on PG-PS administration. The authors suggest that bacterial debris may act similarly in causing ocular inflammation in man.

Effects of small changes of plasma vasopressin on subcutaneous and skeletal muscle blood flow in man

The effect of vasopressin (AVP) on subcutaneous blood flow was studied by the 133Xenon wash-out method in 13 healthy subjects during three consecutive infusions of synthetic AVP, using increasing infusion rates. In seven of them, both subcutaneous and skeletal muscle blood flows were measured during the first infusion. The preinfusion, and infusion pAVP levels were 1.6 +/- 0.4, 3.4 +/- 0.4, 4.9 +/- 0.5 and 8.8 +/- 0.7 pg ml-1, respectively (mean +/- SE). The values are within the range normally found during dehydration. During the AVP infusions, the blood flow in subcutaneous tissues decreased 30-40% and the vascular resistance increased 60-80%. Neither heart rate nor blood pressure change significantly during the infusions. Plasma renin activity (PRA) decreased significantly. After cessation of the infusions, blood flow and vascular resistance rapidly returned to preinfusion values, while PRA increased very slowly. Skeletal muscle and subcutaneous tissues blood flows were found to be equally sensitive to small changes in the pAVP level. The present study has demonstrated that even minor increments of pAVP levels, as seen during dehydration, can significantly alter the regional blood flow in subcutaneous and skeletal muscle tissues in man.

Substitution of aluminium salts by magnesium salts in control of dialysis hyperphosphataemia

For two years all 28 patients undergoing hospital haemodialysis were switched from a dialysate magnesium (Mg) of 0.85 mmol/l to one containing none. Oral aluminium hydroxide was discontinued, and magnesium carbonate was substituted as a phosphate binder. After 24 months on this regimen predialysis aluminium concentration had fallen significantly. There was no significant change in predialysis phosphate, which remained above the normal range; nor was there evidence of increased secondary hyperparathyroidism as judged by parathyroid hormone immunoassay and biochemical or clinical criteria. Predialysis Mg concentrations tended to fall towards the normal range. Aluminium-containing phosphate binders seem to be unnecessary for the control of dialysis hyperphosphataemia. Magnesium carbonate may be an alternative and less toxic compound.

Use of nucleic acid probes for the detection of sexually transmitted infectious agents

Deoxyribonucleic acid sequences specific for a pathogen of interest can be isolated from a variety of microorganisms. Such DNA probes can be exploited to detect infectious agents directly in infected patient material despite the presence of large numbers of other organisms and host DNA. This technology is dependent upon the recognition of a specific nucleotide sequence present in DNA extracted from a clinical sample by a radiolabeled or nonisotopically labeled DNA probe. We have isolated several DNA probes for the detection of pathogenic Neisseria which include a plasmid species unique to the gonococcus, as well as several cloned genes that detect both the gonococcus and the meningococcus. In addition, we characterized a unique plasmid of Chlamydia trachomatis that has proved to be quite useful as a DNA probe for the detection of this pathogen in cervical secretions and, by in situ hybridization, in Papanicolaou smears. Deoxyribonucleic acid hybridization as a diagnostic tool is still in its infancy. It holds a number of advantages over conventional methods of pathogen detection and serves as an alternative, as well as a complement, to available immunologic methods.

Sonography and NMR imaging in rheumatoid gonarthritis

Sonography and NMR imaging of the knee joint make it possible to obtain a visual representation of the thickened synovial membrane occurring in patients with rheumatoid gonarthritis, even before inflammatory deformation is radiologically detectable. Both methods can expose effusions and Baker's cysts. In NMR imaging, an indication of the inflammatory genesis can be obtained from the extended relaxation time T1. Due to the good representation of soft tissues, prognostic evidence may be gained of whether a mainly exudative or proliferative form is present.

Cerebrospinal fluid vasopressin--changes in depression

Cerebrospinal fluid (CSF), thyrotropin releasing hormone (TRH), CSF-vasopressin (AVP), plasma-AVP, CSF-osmolality, plasma-osmolality, CSF-adrenaline (A) and -noradrenaline (NA) were measured in psychiatric patients and controls. Psychiatric patients were classified according to ICD-9 and grouped into endogenous depression, non-endogenous depression, mania and schizophrenia. The depressive groups were classified according to the Newcastle Rating Scale for Depression 1965. Severity of disease was quantified by BRMES, BRMS and BPRS. No difference in CSF-TRH levels was seen among the different diagnostic groups and controls. A positive correlation between CSF-TRH and CSF-A was demonstrated. CSF-AVP concentrations were significantly lowered in both endogenous and non-endogenous depression; no correlation with CSF-A or -NA was seen. Neither did any difference between plasma levels of AVP, plasma-osmolality or CSF-osmolality appear among the groups investigated.

Bed rest and increased diuretic treatment in chronic congestive heart failure

To elucidate the effect of bed rest used as an adjunct to increased diuretic treatment, twelve patients with chronic congestive heart failure (CHF) had a 50% increase in loop diuretic dosage and were allocated to either continuous bed rest or bed rest during nights only. The 24-hour bed rest group reduced their weight significantly (mean +/- SEM: 2.00 +/- 0.79 kg, P less than 0.001), whereas the night bed rest group had no significant weight reduction (1.10 +/- 0.37 kg, 0.1 less than P less than 0.2) during three days of observation. Furthermore, the 24-hour bed rest group had a significantly increased diuresis (P less than 0.05) during the first day of the study and a tendency towards increased natriuresis. The cumulated diuresis for the two groups (24-hour bed rest versus night bed rest) during the three days of study were 7773 +/- 700 ml and 5861 +/- 909 ml (0.05 less than P less than 0.1), respectively. Plasma concentrations of adrenaline, noradrenaline, renin and aldosterone were increased, as measured in the supine position. No significant differences were found between the two groups. Plasma concentrations of antidiuretic hormone were within normal limits. In conclusion, continuous bed rest is a reasonable adjunct to diuretic treatment in patients with CHF.

Peroral treatment of diabetes insipidus with a polypeptide hormone analog, desmopressin

In the present study nine diabetes insipidus patients were treated with desmopressin (DDAVP) tablets. All patients had a significant reduction of their polyuria after a peroral dose of 50 micrograms DDAVP. During a 6-day trial, a peroral treatment with two or three daily peroral doses of DDAVP controlled their polyuria. A dose-response study in five of the patients indicated that peroral DDAVP doses as small as 10 micrograms have effects on renal concentrating ability. A log-linear relationship was found between DDAVP doses and maximal urine osmolalities and duration of antidiuresis. Measurements of plasma DDAVP concentrations after peroral DDAVP revealed a linear relationship between amounts of DDAVP absorbed and dose, but with great interindividual differences. The results indicate that graded renal response occur at plasma concentrations of DDAVP between 1 and 5 pg/ml. The results of this study and the assessment by the patients of the treatment indicate that peroral therapy with DDAVP may be an attractive alternative to traditional intranasal administration of the drug.

[NMR tomography of the knee joint in patients with rheumatic joint diseases]

Twenty patients with rheumatoid gonarthritis were examined in a NMR tomograph with a 0.2 tesla resistive magnet. Synovial effusions were seen in 18 cases and thickening of the synovium in 15 cases. Discrimination between synovial fluid and synovium was gained by different NMR signals from various spin-echo sequences. In demonstrating a thickened synovium NMR tomography enables the depiction of inflammation inside the joint in earlier stages of illness than is possible with bone erosion detection from X-ray photographs.

Cerebrospinal fluid and plasma vasopressin during short-time induced intracranial hypertension

The response of plasma and ventricular cerebrospinal fluid vasopressin concentration to short-time induced intracranial hypertension was studied in 8 patients with hydrocephalus, defined as ventricular enlargement on computerized tomography. In connection with measurement of conductance to cerebrospinal fluid outflow, the concentration of vasopressin in plasma and cerebrospinal fluid was measured during perfusion at a low (less than 10 mmHg) and at a high (greater than 20 mmHg) intraventricular pressure level. Mean plasma vasopressin concentration was increased from 2.4 +/- 0.4 pg/ml (SEM) during perfusion at the low pressure level to 4.2 +/- 0.8 pg/ml (p less than 0.01) at the high pressure level. The cerebrospinal fluid concentrations of vasopressin at the low and high intraventricular pressure were 1.2 +/- 0.1 pg/ml and 1.7 +/- 0.2 pg/ml (p less than 0.05), respectively. However, only half of the patients responded to the increase in intraventricular pressure with an increase in cerebrospinal fluid vasopressin concentration exceeding 50%. The results of the present study suggest that an increase in the intracranial pressure might be a stimulus for vasopressin release in both the blood and the cerebrospinal fluid.

24-hour cerebrospinal fluid levels of vasopressin in hydrocephalic patients

The variation in vasopressin concentrations of ventricular cerebrospinal fluid and plasma throughout a 24-h period was studied in 10 patients with hydrocephalus. In 6 control patients, the diurnal variation in plasma vasopressin concentrations was studied. Vasopressin concentrations were determined by radioimmunoassay in plasma and in extracted and unextracted cerebrospinal fluid. Cortisol and osmolality in plasma were also measured. Vasopressin concentrations measured in extracted cerebrospinal fluid showed only small intra- and interindividual variation, while the corresponding values for unextracted cerebrospinal fluid were 2-5-fold higher and showed more variation. Plasma vasopressin concentrations varied considerably throughout the 24-h period in the individual hydrocephalic patient and between the patients. The pattern of variation was inconstant with no circadian rhythm, and the variation was not related to any changes in plasma osmolality, blood pressure or intracranial pressure. In some of the patients, the normal diurnal pattern of variation in plasma cortisol was broken, however, without a relation to the observed fluctuations in vasopressin concentrations. The abnormal variation of plasma vasopressin and cortisol was considered to reflect stress in connection with the intracranial pressure monitoring procedure. In the control patients, plasma vasopressin showed only small variations and plasma cortisol showed a normal diurnal rhythm. It is concluded that cerebrospinal fluid vasopressin concentration in patients with hydrocephalus is very constant throughout the day, even when plasma vasopressin concentrations show marked episodic increases. Thus, a circadian rhythm in the cerebrospinal fluid vasopressin concentration, as reported in several animal species, could not be confirmed in these patients.

Vasopressin in plasma and ventricular cerebrospinal fluid during dehydration, postural changes, and nausea

The responses of plasma and ventricular cerebrospinal fluid (CSF) vasopressin concentration to dehydration, postural changes, and induction of nausea were studied in 21 patients with hydrocephalus of various etiology. The 24-h dehydration test evoked a significant increase in plasma osmolality and vasopressin concentration, whereas the concentration of vasopressin in CSF was unchanged. Head-up tilt to 50 degrees for 45 min with a tilt bed resulted in a modest increase of plasma vasopressin in patients who did not develop presyncopal symptoms, but no changes were seen in CSF vasopressin. Induction of nausea by subcutaneously injected apomorphine provoked a marked (20- to 50-fold) rise in plasma vasopressin concentration within 15 min, and the plasma concentration was significantly increased above base-line values for 60-120 min. Despite the prolonged period of high plasma vasopressin concentration CSF vasopressin was not influenced by the apomorphine injection. The findings suggest that the concentration of vasopressin in the CSF is controlled by mechanisms other than the well-known osmotic and nonosmotic stimuli of vasopressin release into the blood.

Cerebrospinal fluid vasopressin in neurological and psychiatric disorders

Vasopressin was determined in CSF and plasma of 243 patients with different neurological and psychiatric disorders, including control patients. CSF vasopressin was significantly higher in patients with high pressure hydrocephalus, intracranial tumour, benign intracranial hypertension, intracranial haemorrhage, ischaemic stroke, and craniocerebral trauma. In patients with primary degenerative dementia, CSF vasopressin was lower than in control patients. Among patients with psychiatric disorders, CSF vasopressin was increased in manic patients, while in patients with depression CSF concentration of this hormone did not differ from that found in controls. However, an increase in CSF vasopressin level was found in patients recovering from a depression. The clinical significance of changes in CSF vasopressin concentrations in groups of patients with neurological and psychiatric disorders is still unknown.

Chlorpromazine increases the lowered response to antidiuretic hormone in rats with lithium-induced diabetes insipidus

The interaction between chlorpromazine (CPZ) and lithium on renal concentrating ability was studied in rats fed a Li-containing diet for 8 weeks (plasma-Li 0.6-0.7 mmol/l). CPZ (15 mg/kg daily orally) reduced the polydipsia and increased the ability to concentrate the urine upon water deprivation in rats treated with lithium. CPZ also reduced systolic blood pressure, but had no effect on the glomerular filtration rate or plasma levels of arginine vasopressin (AVP) in hydrated rats treated with lithium. However, CPZ prevented the rise in plasma AVP levels observed in lithium-polyuric rats in response to dehydration. During anaesthesia CPZ partially restored the impaired anti-diuretic response to exogenous AVP in rats treated with lithium. CPZ had no influence on plasma-Li levels in rats treated with lithium. It is suggested that CPZ by unknown mechanisms interferes with the effects of lithium on the water permeability response to AVP.