Oxidative metabolism of polymorphonuclear leukocytes and serum opsonic activity in chronic renal failure

Luminol-amplified chemiluminescence was used to study the oxidative metabolism of polymorphonuclear leukocytes (PMN), in resting state and in response to opsonized zymosan, in 65 patients with different degrees of chronic renal failure (CRF) or on regular dialysis treatment (RDT). Every patient was compared on the same day with a normal subject. Furthermore, the serum opsonic activity was evaluated, cross-matching zymosan opsonized by serum from CRF-RDT patients and normals with PMN from CRF-RDT patients and normals. PMN resting chemiluminescence showed a progressive increase inversely related to the glomerular filtration rate, and it remained high in patients on RDT. Zymosan-activated chemiluminescence indicated a deficit in phagocytosis for PMN of patients with a glomerular filtration rate lower than 10 ml/min, persisting in RDT patients. The serum opsonic activity was always significantly lower in CRF and in RDT patients than in the control group; this defect was already present in patients with mild renal impairment. Our findings suggest that PMN from CRF or RDT patients have an increased reactive oxygen metabolite production in the resting state that may cause cell and tissue damage; the opsonization impairment and the decreased PMN phagocytic activity contribute to increased vulnerability to infection in these patients.

Effects of biofiltration versus hemofiltration in the treatment of chronic uremia

Biofiltration (BF), a new depurative hemo-diafiltration employing a high efficiency membrane (acrylonitrile and metallylsulphonate of sodium) and reinfusion of 8-9 liters of fluid was tested as an alternative method to hemofiltration (HF). Sixteen uremic patients who showed circulatory instabilities during traditional hemodialysis (HD) were treated with HF (27 liters infused in postdilution), or BF (210 min/session) for 12 months. Low and middle molecular weight metabolites weekly clearances, calcium, phosphorus and bicarbonate serum levels in BF and HF showed no significant differences: in BF the incidence of symptomatic hypotension events and orthostatic changes of mean blood pressure were lower than in HD, but a little higher than in HF. Our results show that BF achieves satisfactory depuration of low and middle molecular weight metabolites in a shorter time than HF and an improvement of autonomic nervous system abnormalities is observed.

Acid-base balance during biofiltration (BF)

Acid base balance during biofiltration (BF): Six patients on standard acetate hemodialysis (HD) were switched to BF with 1 m2 AN69-S membrane, 12 hours weekly (BF-4h) and, later on, to a stage with 1.2 m2 AN69-S, 9 hours weekly (BF-3h). During BF, in order not to exceed 25 mEq/l in intradialytic arterial HCO3, arterial acid-base was examined hourly and a mean of 178 and 199 mEq of HCO3 respectively were infused in BF-4h and BF-3h. We obtained a better control of acidosis with a reduction of the intradialytic pCO2 decrease and hypoxemia. The amount of HCO3 infused was related to the patients deficit in HCO3 total pool and therefore it can be predicted, to avoid postdialytic alkalosis.

Radioimmunoassay of gastrin in human saliva

We have developed a personal procedure for the radioimmunoassay of gastrin (lower detection limit 3 pg/ml). Using 5-fold concentrated lyophilized salivary samples, we are able to detect the basal content of gastrin immunoreactivity in saliva of normal fasting people (mean +/- SD: 1.38 +/- 0.61 pg/ml) compared to plasma gastrin (mean +/- SD: 28.88 +/- 11.00 pg/ml). We found that after meal stimulus, the value of salivary as well as plasma gastrin concentration increased (the correlation coefficient r among salivary and plasma gastrin being 0.899; p less than 0.001). We believe that gastrin appears in a very low concentration in saliva and that it is not produced by the gland, but derives probably from the serum clearance.

Calcitonin increases peripheral plasma somatostatin-like immunoreactivity levels in humans

Even though the inhibitory effects of CT on both hormone secretion and gastrointestinal functions have been well established, the exact mechanism of action still remains unclear. Since the effects of CT can be reproduced by somatostatin, we studied in man the effect of SCT on peripheral plasma SLI levels. Immediately after the onset of CT infusion SLI rose from its mean basal value of 45 +/- 5.5 pg/ml to a peak value of 91 +/- 11 pg/ml (p less than 0.005). SLI levels were still significantly elevated at 30 (p less than 0.05), 45 (p less than 0.05), 90 (p less than 0.005) and 120 min (p less than 0.02). Our results, in good agreement with the previous report by Chiba et al. on isolated perfused rat stomach, suggest that CT effects may, at least in part, be mediated by endogenous somatostatin release.

A new case of familial partial generalized resistance to thyroid hormones: study of 3,5,3'-triiodothyronine (T3) binding to lymphocyte and skin fibroblast nuclei and in vivo conversion of thyroxine to T3

A clinically euthyroid 30-yr-old man with high serum levels of both total (T4, 14.5 micrograms/dl; T3, 272 ng/dl) and free (FT4, 33 pg/ml; FT3, 9.7 pg/ml) thyroid hormones and inappropriately normal TSH levels, both basally and after TRH stimulation, is described. Peripheral indices of thyroid hormone action and the patient's clinical status were not modified by the prolonged administration of supraphysiological doses of both T4 (up to 900 micrograms/day) and T3 (up to 80 micrograms/day), which decreased but did not completely abolish the TSH response to TRH. However, the TSH response to TRH was normally blunted by dexamethasone administration, which also reduced serum T4 and T3 levels to normal. T3 binding to nuclei of mononuclear leukocytes and cultured skin fibroblasts was normal. The overall pattern demonstrates that the patient was affected by partial peripheral resistance to thyroid hormone action. Study of the patient's family revealed the same hormone pattern in the patient's father, suggesting an autosomal dominant mode of inheritance. An in vivo study performed after the iv injection of tracer doses of [125I]T4 and [131I]T3, demonstrated increased production rates (PR) of both T4 [PR, 113.0 micrograms/day X m2; normal subjects, 55.4 +/- 12.3 (mean +/- SD); n = 13] and T3 (PR, 41.1 micrograms/day X m2; normal subjects, 16.3 +/- 2.7). In vivo conversion of T4 to T3 was also evaluated in the patient; a nearly normal T4 to T3 conversion factor was found (0.3108 vs. 0.2576 +/- 0.0422 in normal subjects). In four hyperthyroid patients, the T4 to T3 conversion factors were similar (0.2932 +/- 0.0600), while the PRs of T4 and T3 were increased (PR of T4, 308.6 +/- 85.6; PR of T3, 110.3 +/- 35.0 micrograms/day X m2) compared to those in the normal subjects.

Spontaneous intramural haematoma of the oesophagus

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Intermittent hypoendorphinaemia in migraine attack

Beta-endorphin (RIA method, previous chromatographic extraction) was evaluated in plasma of migraine sufferers in free periods and during attacks. Decreased levels of the endogenous opioid peptide were found in plasma sampled during the attacks but not in free periods. Even chronic headache sufferers exhibited significantly lowered levels of beta-endorphin, when compared with control subjects with a negative personal and family history of head pains. The mechanism of the hypoendorphinaemia is unknown: lowered levels of the neuropeptide, which controls nociception, vegetative functions and hedonia, could be important in a syndrome such as migraine, characterized by pain, dysautonomia and anhedonia. The impairment of monoaminergic synapses ("empty neuron" condition) constantly present in sufferers from serious headaches, could be due to the fact that opioid neuropeptides, because of a receptoral or metabolic impairment, poorly modulate the respective monoaminergic neurons, resulting in imbalance of synaptic neurotransmission.

Plasma hormone assay in pregnancy

This paper reports the results obtained with various hormonal parameters (HPL, E3, alpha-FP) in evaluating fetal wellbeing during pathologic pregnancies. The expression of hormonal parameters in terms of standard deviation (S.D.) provides a constant endocrine index throughout pregnancy, independently of the adopted parameter. Such methodology reduces error and simplifies interpretation of data. The hormonal index is important not only for reliable diagnosis of a pathologic situation, but also because of its simple interpretation for clinical and practical purposes.

Comparison of arginine and insulin stimuli on pituitary GH secretion

Ninety subjects, of both sexes, affected by growth failure, were tested comparatively with insulin and arginine stimuli. This latter, if performed at a dose of 0.8 g/kg, results to be the most efficient test, regardless of sex.

GH secretion by arginine stimulus: the effect of both low doses and oral arginine administered before standard test

Small arginine doses (2 ml of 10% - 200 mg - arginine monohydrochloride i.v. administered) are capable of provoking a significant GH secretion. No correlation was found between GH peak observed after this administration and that observed after a standard arginine stimulus (24.8 g) performed subsequently. GH response to a standard arginine stimulus was blunted, differently from the response to insulin stimulus, by a previous oral arginine administration.

[Transcutaneous renal needle-biopsy guided with ultrasonics]

Authors performed percutaneous renal biopsy guided by ultrasounds in 10 patients in whom urography was dangerous or did not provided good renal images. The advantages of this method are in the directional and dimensional accuracy of ultrasound scanning, so that the exact topography of the kidney can be established. The use of ultrasonically guided renal biopsy is mainly recommended in iodine medium idiosyncrasy, in myelomas and renal failure. This method can be preferred in order to establish the exact topography of kidney, in acute anuric renal failure, in chronic failure (when high doses of iodate contrast are needed), and in the presence of cyst.

Long-term use of a "stable" bicarbonate containing dialysate

We present an original method for the preparation of "stable" dialysate containing 35 mEq/l of bicarbonate. The dialysate was utilized with 4 patients for periods ranging from 4 months to 1 year according to a short-term recirculated dialysis schedule in closed circuit (20-40L) (2-2 1/2 hrs) on alternate days. Preliminary results are reported here with respect to the tollerance of the dialytic run and correction of the acid-base balance equilibrium. The clinical tollerance is excellent despite high dehydration rates even in patients particularly sensitive to ultrafiltration. The acidosis correction would seem to be much better with bicarbonate than with traditional dialysis. The difference is even higher if we consider the brevity of the dialysis. During the bicarbonate dialysis we do not observe any fall of the PCO2 or significant difference in PO2 in the patient's blood. The correction of acidosis probably causes the normalization of pre-dialytic potassiemia in spite the "net" removal of K with short dialysis is considerably less.