Effect of cimetidine on granulocyte-macrophage colony formation by normal and chronic renal failure bone marrow cells

The effect of cimetidine, an antihistaminic blocker of the H2 receptors, on the development of granulocyte-macrophage colonies (GMC) was examined in vitro on bone marrow cells from healthy individuals and chronic renal failure (CRF) patients. The drug caused a dose-dependent decrease in the number of GMC from bone marrow samples in both healthy subjects and patients, being much more expressed in the latter group. The addition of urea to bone marrow cultures of healthy subjects increased the inhibition of colony formation caused by cimetidine alone. CRF or control serum added to normal bone marrow cells enhanced the colony growth which was significantly more expressed when using a CRF serum sample.

Should cholecystography or ultrasound be the primary investigation for gallbladder disease?

The conclusions drawn from a prospective survey of 500 patients examined by cholecystography (OCG) and ultrasound (UCG) are presented. First, both procedures were found to be highly accurate in detecting calculi, with false-negative rates of 1%. Secondly, if OCG is abandoned in favour of UCG, most acalculous adenomyomatosis (and many polyps) will not be diagnosed. If acalculous as well as calculous disease is regarded as clinically important, fluoroscopic OCG is the examination of choice. However, if a clinician wishes solely to find or exclude stones the investigations are equally accurate. Thirdly, since some calculi and some acalculous disease will be missed by either technique, serious consideration should be given to the further investigation of all gallbladders considered normal by either examination. A protocol is described which, though unorthodox, enables a decision on the status of the gallbladder to be made on a single visit to the radiology department.

Generation of superoxide anions during phagocytosis by monocytes of uremic patients

The phagocytic activity of monocytes from 15 uremic patients was estimated by the superoxide anion test. There was a significant decrease in the ability of monocytes from these patients to produce superoxide anions in comparison with monocytes obtained from healthy subjects. Addition of urea to monocytes from healthy subjects caused a marked reduction in their ability to produce superoxide anions, while addition of creatinine did not cause any effect. Monocytes from patients with renal failure of glomerular origin were found to produce less superoxide anions than those from patients with other types of renal diseases.

Neuraminidase-like activity in sera of uremic anemic patients

A shortened life of erythrocytes in uremia has been suggested as one of the causes of anemia in this condition. Since partially desialylated erythrocytes are promptly removed from the circulation, we examined whether sera from renal failure patients would exhibit increased neuraminidase activity which could be held responsible for this phenomenon. Sera of 22 patients with end stage renal failure were examined for neuraminidase activity by assessing their effect on desialylation upon incubation at 37 degrees C for 2 and 1 h, respectively, of erythrocytes of healthy donors matched for blood group and of fetuin as substrate. As deduced from the residual content of sialic acid of erythrocytes and of the amount of sialic acid released from fetuin, the results showed a statistically higher neuraminidase-like activity of patients' sera as compared to sera of healthy individuals. It is suggested that increase in neuraminidase activity could be one of the factors involved in the mechanism of generation of anemia in uremia by acting on erythrocytes, rendering them more prone to sequestration by the liver and spleen.

Chronic alcohol excess is associated with selective but reversible injury to type 2B muscle fibres

Patients drinking more than 100 g alcohol/day for longer than three years develop atrophy of striated muscle fibres. This predominantly affects type 2B fibres which are dependent on anaerobic glycolytic metabolism. Atrophy of type 1 and type 2A fibres, which in addition use aerobic mitochondrial respiration, only occurs in the most severe cases and then only to a lesser degree. Abstention from alcohol reverses the changes in muscle which slowly return to normal. Selective injury to type 2B fibres indicates that search should be made for an alcohol-induced biochemical lesion affecting the anaerobic glycolytic pathways of the muscle fibre.

Epithelial patchy necrosis in Crohn's disease

Electron and light microscopic studies of the intestinal epithelium in Crohn's disease demonstrated localized areas of damage to the superficial epithelium, occurring without accompanying acute inflammation. In a blind study of rectal biopsy specimens from seven patients with Crohn's disease, four with ulcerative colitis, and four normal controls, this finding of patchy necrosis without acute inflammation was observed exclusively in four of the seven cases of Crohn's disease.

Acquired cystic disease and tumors in kidneys of hemodialysis patients

During the period 1975-81, autopsies were performed in 15 patients who had been treated by long-term hemodialysis and who had no clinical or family history of polycystic disease. Ten of the patients were found to have bilateral cystic disease of the kidneys. In 3 of the 10 patients with cystic kidneys, tumors were found: a solid tubular adenoma in one, multiple bilateral papillary adenomas in another, and clear cell tubular carcinoma in the third. Hemorrhages were not detected in any of the patients. The results of our study confirmed that patients on hemodialysis have a very high incidence of acquired cystic disease and are at high risk of developing neoplasms in their contracted kidneys.

Sexual dysfunction associated with hyperprolactinemia in males and females undergoing hemodialysis

Fifty-nine uremic patients (38 males and 21 females) maintained on chronic hemodialysis (CHD) served as the subjects in a study of the relationship between sexual dysfunction and serum prolactin levels (SPL). Sexual desire and activity were evaluated by a self-report sexual function rating scale (SFRS). About half the population of this study reported sexual dysfunction. Males and females reporting disturbance of sexual function had significantly higher SPL than those with normal sexual function. Bromocriptine treatment in five hyperprolactinemic patients reduced SPL to normal range and improved the sexual function. Association between sexual dysfunction and hyperprolactinemia in uremic patients is suggested.

Clinical-echocardiographic correlations in acute rheumatic fever

Thirty-three children with acute rheumatic fever were studied using echocardiography to characterize heart involvement in this disease. Among 26 subjects with a first episode of acute rheumatic fever, 18 had a clinical diagnosis of carditis and six had heart failure. Heart failure usually resulted from valvular incompetence rather than from myocardial failure in these patients. Conversely, among seven subjects with recurrent rheumatic fever, five had a clinical diagnosis of carditis and four had heart failure. Severe left ventricular dysfunction noted on echocardiography probably contributed significantly to the appearance of heart failure in two of these four subjects. Ten patients were initially believed not to have carditis: a diagnosis of mitral valvulitis was made in two of these ten on the basis of the results of the echocardiographic examination. Echocardiography, which provides important information on the cardiac status of patients with acute rheumatic fever, may help in assessing the prognosis and may be useful in the therapy of these patients.

Hepatic lesions in patients on anabolic androgenic therapy

The histopathological changes in the livers of 11 patients treated with alkylated and nonalkylated anabolic androgenic steroids are presented. The histological changes in the liver included: proliferation of the bile ducts with or without cystic dilatation (9/11), peliosis (8/11), atypical hyperplasia of liver cells (2/11), and tumors (3/11). The latter included one case of cholangiocarcinoma, one of hepatocellular carcinoma, and one of combined cholangiocellular and hepatocellular carcinoma. The pathological changes in the liver in this series suggest a possible relationship between anabolic androgenic steroids and bile duct proliferation and/or cholangiocarcinoma.

Effect of heparin on lipoprotein profile during parenteral fat infusions

Long-term administration of Intralipid to infants raises the potential risk of cumulative hyperlipemia. The elimination of lipoproteins from the blood during 3 hours of Intralipid infusion (0.33 grams per kilogram per hour) was investigated in five term infants during two infusion periods without and with heparin. A single intravenous injection of heparin (100 micron per kilogram) preceded the period of Intralipid infusion. During the nonheparin periods levels of triglycerides (L-particles) rose progressively to 1320 +/- 133 milligrams per 100 milliliters plasma, whereas during the heparin periods levels rose more moderately and peaked at 636 +/- 197 milligrams per 100 milliliter plasma (p less than 0.001-0.05). The study suggests that the heparin effect is still apparent for a period of 6 hours and repeated bolus injections may keep triglyceride levels at approximately normal concentrations during constant Intralipid infusion (0.166 grams per kilograms per hour).

Diagnosis of pancreatic abscess via percutaneous aspiration

The pre-operative diagnosis of a pancreatic abscess was not considered in a comprehensive review in 1972. However, advances in technology (Ultrasound--US, Computed Tomography--CT) has allowed guided percutaneous needle aspiration (PNA) of suspected pancreatic lesions. The purpose of this study was to evaluate the safety and diagnostic ability of PNA to differentiate acute pancreatic inflammatory masses from pancreatic abscess (PA). Thirteen patients underwent PNA after US or CT revealed an acute pancreatic inflammatory mass (12/13 cystic). One patient underwent a second aspiration. Clinical features T degrees--101.3 degrees F mean (13/13), leukocytosis 14,400 cu/mm (11/13). Aspirated material was gram-stained and examined for bacteria and leukocytes and cultured.

RESULTS

PNA was accomplished successfully in all patients. Aspirate revealed bacteria in nine and pancreatic abscess was confirmed at surgery (8) or post-mortem exam (1). Four of five patients in whom no bacteria were visualized had medical resolution, the fifth had continued T degree and underwent a second aspiration which diagnosed a PA. PA contained moderate to large number of PML via aspiration.

CONCLUSIONS

PNA provides a potentially important and safe diagnosis adjunct to earlier accurate differential diagnosis of pancreatic inflammatory masses from pancreatic abscess.

Effect of parathyroid hormone on osmotic fragility of human erythrocytes

The survival of erythrocytes (RBC) is shortened in uremia, and it has been shown that calcium influx into RBC evoked crenation and increased their rigidity. The high blood levels of parathyroid hormone (PTH) may augment entry of calcium into RBC and hence affect their integrity. We examined the effect of PTH on osmotic fragility of human RBC and investigated the mechanisms through which PTH interacts with RBC. Both the amino-terminal (1-34) PTH and the intact (1-84) PTH, but not the carboxy-terminal (53-84) PTH, produced significant increases in osmotic fragility. This effect was abolished by prior inactivation of the hormone. There was a dose-response relationship between both moieties of PTH and the increase in osmotic fragility. This action of PTH required calcium, was mimicked by calcium ionophore, and was partially blocked by verapamil. PTH caused significant influx of (45)Ca into RBC, which was not associated with potassium leak. The hormone did not affect water content of RBC. Scanning electron microscopy revealed that the incubation of RBC with PTH was associated with the appearance of membrane filamentous extensions, which anchor RBC together. Inhibition of glycolytic activity of RBC with NaF or inhibition of Na-K-activated ATPase with ouabain did not abolish the effect of PTH on osmotic fragility. PTH did not stimulate RBC Na-K-activated ATPase or Mg-dependent ATPase but caused marked and significant stimulation of Ca-activated ATPase. The basal activity of the RBC adenylate cyclase was low and PTH produced only a modest stimulation of this enzyme. Both cyclic AMP and dibutyryl cyclic AMP had no effect on osmotic fragility. THE DATA INDICATE THAT: (a) the RBC is a target organ for PTH, (b) the hormone increases osmotic fragility of RBC, and (c) this effect of PTH is due to enhanced calcium entry into RBC. We suggest that the increased calcium influx may affect the spectrin-actin of the cytoskeletal network of the RBC and may alter the stability and integrity of the cell membrane. This action of PTH on the RBC could be, at least in part, responsible for the shortened survival of RBC in uremia, and assign a new role for PTH in the pathogenesis of the anemia of uremia.

Effects of parathyroid hormone on oxidative phosphorylation of heart mitochondria

In an effort to understand the mechanism of action of parathyroid hormone (PTH) on the myocardium, we examined the effect of PTH on the function of isolated heart mitochondria. The hormone inhibited mitochondrial respiration in the presence of malate or beta-hydroxybutyrate but not succinate as substrates. It also inhibited phosphorylation and uncoupled oxidative phosphorylation. These effects of PTH were dose dependent and occurred only in the presence of calcium. A change in calcium concentration from zero to 2 mM did not affect mitochondrial function. PTH also stimulated mitochondrial ATPase. The inhibitory effect of PTH on mitochondrial respiration and on oxidative phosphorylation would result in decreased ATP synthesis and, hence, reduced availability of ATP. Such a sequence of events may provide an explanation for a potential long-term adverse effect of the hormone on the myocardium.

Tuberculosis in patients on hemodialysis

Six of 102 patients with end-stage renal disease (ESRD) who underwent hemodialysis treatment from 1972 to 1980 developed active tuberculosis (TB). Three of six patients were Yemenite Jews, an ethnic group constituting only 10.8% of the dialysis population; thus, Yemenite Jews appear to be especially at risk among Israeli dialysis patients. Fever of unknown origin was the most frequent presenting symptom. In four patients, previous TB of the lungs was documented. These data support the view of reactivation of dormant TB as the main pathogenetic pathway for the development of the active disease. Two patients died, whereas four recovered on triple therapy with isoniazid, rifampicin and ethambutol.

Elevated thrombocyte calcium content in uremia and its correction by 1 alpha(OH) vitamin D treatment

Intracellular calcium plays an important role in the regulation of platelet function. It has also been demonstrated that platelet functions are impaired in uremia. A rise in intracellular calcium has been shown in several tissues and has been held responsible for the impaired function of several organs seen in uremia. This study was undertaken to evaluate whether the calcium (Ca) content of thrombocytes is elevated in uremia and, if so whether treatment with an active vitamin D metabolite might correct this abnormality. In 10 patients on chronic hemodialysis, platelet Ca content was determined by a technique utilizing consecutive freezing and thawing of platelet-rich plasma. The platelet Ca content of uremic patients was found to be markedly higher (20.86 +/- 0.9 ng/200,00 platelets, p less than 0.01) than that of a group of 20 normals (12.8 +/- 1.2 ng/200,000 platelets). 1 months after treatment with 1 alpha (OH) vitamin D at a dosage of 0.5-2.5 microgram/day, the platelet Ca content of the dialysis patients decreased to 14.99 +/- 2.14 ng/200,000 platelets (p less than 0.05). The data show that in dialysis patients the platelet Ca content is markedly elevated in comparison with that of normals, and the treatment with 1 alpha (OH) vitamin D may significantly reverse this abnormality. It is suggested that elevated Ca content may play a role in the pathogenesis of uremic platelet dysfunction, and that 1 alpha (OH) vitamin D administration may be of benefit in correcting this disorder.

The morphological changes in acute renal failure due to rhamdomyolysis following viral infection

A case of myoglobinuric renal failure associated with viral rhabdomyolysis is described. Clinical signs of muscle involvement were lacking, but peculiar biochemical abnormalities suggested the diagnosis which was established by renal biopsy. The management required brief supportive hemodialysis, and the patient recovered. The diagnosis of myoglobinuria should be considered when acute renal failure develop subsequently to the onset of viral infection.

Etiology, warning signs and therapy of torsade de pointes. A study of 10 patients

Torsade de pointes, also called atypical ventricular tachycardia (AVT), was diagnosed in 10 patients, nine on antiarrhythmic therapy and one with acute central nervous system damage. Four patients received quinidine and five disopyramide, either alone or in combination with amiodarone. AVT was dose-dependent in some, but in others, it started shortly after initiation of drug therapy (idiosyncrasy). All patients had QT prolongation longer than 0.60 second immediately before the onset of AVT. This measurement appeared to be a more sensitive predictor of the development of AVT than QTc prolongation or QRS widening. All patients also showed bradycardia before AVT onset. After therapy, the QT immediately decreased, while QTc and QRS remained prolonged for longer periods. Isoproterenol was effective in five of seven patients, but was contraindicated in two others. Ventricular pacing was used in four patients, including the two who did not respond to isoproterenol, and this abolished AVT promptly. Isoproterenol or pacing appear to be the therapy of choice for AVT, while the conventional drugs used to treat the usual form of ventricular tachycardia are not only ineffective, but even contraindicated.

Synthesizing activity and ultrastructural findings of human blood cells after incubation with cis-platinum "in vitro"

The synthesizing activity and ultrastructural appearance of human polymorphonuclears, lymphocytes and platelets obtained from healthy donors were examined after incubation with cis-platinum (cis-Pt). The drug caused a statistically significant inhibition of DNA, RNA and protein synthesis of the lymphocytes, but their ultrastructure appeared unchanged. On the other hand, incubation of polymorphonuclears with cis-Pt did not affect their protein synthesis but caused a decrease in the number of cytoplasmic granules, mitochondrial alterations, and appearance of membrane ruffles. The drug induced neither inhibition of platelet protein synthesis, nor ultrastructural alterations. The selective effect of this drug on the synthesizing activities of human lymphocytes may be of potential value in the treatment of lymphoproliferative and immunological disorders in man.