Pain perception following subcutaneous injections of citrate-buffered and phosphate-buffered epoetin alpha

Subcutaneous injection of citrate-buffered epoetin alpha (EPO-alpha) causes pain. Substitution of citrate buffer with a phosphate buffer in the EPO-alpha resulted in a significant reduction in duration and severity of pain. It is possible that sodium citrate which is present in the EPO-alpha may be the agent that causes discomfort in the patients.

Chronic steroid sulfatase inhibition by (p-O-sulfamoyl)-N-tetradecanoyl tyramine increases dehydroepiandrosterone sulfate in whole brain

Dehydroepiandrosterone sulfate (DHEAS) is a neurosteroid which functions as a negative allosteric modulator of the GABA(A) receptor-gated chloride channel. Steroid sulfatase inhibitors including (p-O-sulfamoyl)-N-tetradecanoyl tyramine (DU-14), can potentiate the blockade of the amnestic effects of scopolamine by exogenously administered DHEAS. Moreover, when administered over a 15 day period, DU-14 can block scopolamine amnesia without the concurrent administration of DHEAS. Since the enzyme, steroid sulfatase, facilitates the hydrolysis of the sulfate moiety from DHEAS, the intent of this study was to determine whether chronic administration of DU-14 could increase whole brain concentrations of endogenous DHEAS. Rats were administered DU-14 or corn oil vehicle for 15 days. Following the last day the animals were sacrificed and the brains were removed and analyzed for DHEAS content. DU-14 increased the whole brain concentration of DHEAS 77.6%, from 0.65 +/- 0.06 to 1.15 +/- 0.12 microg/g (mean +/- SEM). This result suggests that steroid sulfatase inhibitors may enhance cognitive function following chronic treatment by increasing the concentration of excitatory neurosteroids such as DHEAS in the brain. Steroid sulfatase inhibitors, therefore, may provide a novel mechanism for facilitating central nervous system function.

Enhanced plasma DHEAS, brain acetylcholine and memory mediated by steroid sulfatase inhibition

Steroid sulfatase inhibitors can alter the metabolism of neurosteroids which modulate brain function. Administration of the non-steroidal steroid sulfatase inhibitor (p-O-sulfamoyl)-N-tetradecanoyl tyramine (DU-14) to rats for 15 days increased plasma dehydroepiandrosterone sulfate (DHEAS) concentrations by 88.2%, decreased plasma dehydroepiandrosterone (DHEA) concentrations by 84.6%, increased hippocampal acetylcholine (ACh) release determined via in vivo microdialysis by almost 3-fold, and produced a significant blockade of scopolamine-induced amnesia as measured by a passive avoidance test. These results suggest DHEAS rather than DHEA enhances brain cholinergic function and that steroid sulfatase inhibition may become an important tool for enhancing neuronal functions, such as memory, mediated by excitatory neurosteroids.

Association of IgA nephropathy with T-cell receptor constant alpha chain gene polymorphism

T-cell receptor (TCR) proteins recognize a complex of an antigen-derived peptide bound to the cell surface products of the major histocompatibility complex (MHC) that could be of importance in the immunopathogenesis of IgA nephropathy (IgAN). Previous studies found no difference on TCR constant beta chain gene frequencies in IgAN compared with control. Yet no study on the TCR alpha gene in IgAN was reported. We studied the TCR C alpha gene polymorphisms by restriction fragment length polymorphism (RFLP) in 53 patients with IgAN and in comparison with 67 healthy controls. The patients were also classified into different histopathological grading (I, II, and III with increasing histological severity) and renal functions. The extracted DNA were digested with Taq I enzymes and probed with a full-length TCR-alpha cDNA clone p1.2alpha probe. A 7-kb C-alpha Taq 1 fragment is found in 32 of 53 patients (60.3%) compared with 26 of 67 controls (38.8%) (P < 0.05). There was no association of any polymorphic fragment, including the 7-kb fragment, with either the histological grading or renal function. It is concluded that the TCR C-alpha gene is associated with IgAN but not with the prognosis of the disease.

In vitro effects of simulated gastric juice on swallowed metal objects: implications for practical management

BACKGROUND

Swallowed metal objects often pose a technical challenge for the endoscopist. We studied in vitro the effects of simulated gastric juice on metal objects commonly encountered in endoscopic practice and measured the physical-chemical changes.

METHOD

Razor blades, disc batteries, and pennies were incubated in simulated gastric juice at 37 degrees C. The weights of the objects were recorded hourly. When no change could be detected, the solution was subjected to mass spectrometry to verify absence of effect. The findings were correlated with clinical observation in one patient who swallowed razor blades repeatedly.

RESULTS

Dissolution of the razor blade was proportional to the duration of acid immersion. At 24 hours, the blades weighed 63% of the original weight. Double-edged razor blades could be broken with a snare at 15 hours. The thickened back of the single-edged blade totally dissolved in 2 hours. No leak of contents could be detected with disk batteries. Pennies were unaffected.

CONCLUSION

Corrosion of razor blades occurs rapidly in the normal stomach. Within 24 hours double-edged blades become fragile and can be broken with a snare. This observation may guide the timing of endoscopic removal. Modern disk batteries are acid resistant for 24 hours.

Dialysis adequacy of Asian patients receiving small volume continuous ambulatory peritoneal dialysis

The usage of three x 2 liter daily exchanges is adopted as the standard CAPD regime in Hong Kong over the last 10 years due to budgetary constraint. This dialysis prescription is considered suboptimal in Western standard. However, the necessity of maintaining Kt/V > 1.7 for CAPD dialysis adequacy is not unanimously agreed. We performed a cross-sectional study of 117 patients on CAPD. Seventy-eight percent of our patients had 3 x 2 liter daily exchange while the rest had 4 daily exchanges. Fifteen percent of patients were diabetic. Patients with Kt/V < 1.7 were similar to those with Kt/V > 1.7 in age, duration of CAPD, BUN, plasma creatinine, albumin, peritonitis rate, and incidence of hypertension. Patients with Kt/V > or = 1.7 had higher hemoglobin, higher nPCR, more residual renal function; and more of them received 4 daily exchanges. Their peritoneal permeability did not differ. Their employment and rehabilitation status was also similar. Our 5-year survival was 79% despite a lower Kt/V. Notably, the protein catabolic rate of our patients was higher than that in Western patients. This is likely due to dietary difference. Our study suggests small-volume dialysis may be acceptable in Asian population with smaller body size given the financial constraint.

Synthesis of sodium androst-5-ene-17-one-3 beta-methylene sulfonate

The synthesis of sodium androst-5-ene-17-one-3 beta-methylene sulfonate 2, a stable analog of memory-enhancing neurosteroid dehydroepiandrosterone sulfate, is described. The synthesis of compound 2 is carried out in six steps from dehydroepiandrosterone.

Structure-activity relationship studies of the amide functionality in (p-O-sulfamoyl)-N-alkanoyl tyramines as estrone sulfatase inhibitors

Recently, we reported the synthesis and biomedical studies of a series of (p-O-sulfamoyl)-N-alkanoyl tyramines as nonsteroidal estrone sulfatase inhibitors. One of the most potent inhibitors in this series is (p-O-sulfamoyl)-N-tridecanoyl tyramine 1 with an 1C50 value of 61.3 nM. In this study, we synthesized four analogs of 1 (compounds 2-5) to investigate the structure-activity relationships of the amide functionality in (p-O-sulfamoyl)-N-tridecanoyl tyramine. Replacement of the amide functionality in 1 with an ethylene moiety to form the alkyl analog 5 resulted in complete loss of sulfatase inhibitory activity (IC50 of 61.3 nM vs. > 20 microM). The keto, hydroxy, and ester analogs (inhibitors 2-4) are 8-15 times less in affinity to the sulfatase than inhibitor 1. However, their inhibitory activities are significantly higher than the alkyl analog 5. The results suggest that the amide functionality is favorable for sulfatase inhibitory activity and that there may be a hydrogen bonding component to the enzyme interaction in this region.

Inhibition of estrone sulfatase and proliferation of human breast cancer cells by nonsteroidal (p-O-sulfamoyl)-N-alkanoyl tyramines

Estrogen levels in breast tumors of postmenopausal women are as much as 10 times higher than estrogen levels in plasma, presumably due to in situ formation of estrogen. The major source of estrogen in breast cancer cells may be the conversion of estrone sulfate to estrone by the enzyme estrone sulfatase. Thus, inhibitors of estrone sulfatase have potential for the treatment of estrogen-dependent breast cancers. Several steroidal agents have been developed that are potent estrone sulfatase inhibitors, most notably estrone-3-O-sulfamate. However, these compounds may be metabolized to forms that have undesired actions, including estrogenicity. To avoid the problems associated with a potentially active steroid nucleus, we designed and synthesized a series of (p-O-sulfamoyl)-N-alkanoyl tyramines as nonsteroidal estrone sulfatase inhibitors. These nine compounds differ in the length of their alkanoyl chains. We tested the ability of the (p-O-sulfamoyl)-N-alkanoyl tyramines to inhibit: (a) estrone sulfatase activity in intact cultures of human breast cancer cells (MDA-MB-231); and (b) the growth of estrogen-dependent human breast cancer cells (MCF-7). All of the test compounds (1 microM) inhibited the estrone sulfatase activity of intact MDA-MB-231 cells; however, compounds with a longer alkanoyl chain were more effective than those with a shorter chain. Dose-response analysis indicated an IC50 of 350 nM for (p-O-sulfamoyl)-N-tetradecanoyl tyramine for the inhibition of MDA-MB-231 estrone sulfatase activity. The inhibition of MDA-MB-231 cell estrone sulfatase activity by this compound was found to be irreversible. Cell proliferation assays involved the treatment of estrogen-deprived MCF-7 cells with test compounds (10 microM) in the presence of estrone sulfate (1 microM) as the only source of estrogen. All compounds inhibited cell proliferation to some extent, but the longer-chain analogues again were more effective. Dose-response analysis indicated an IC50 of 38 nM for (p-O-sulfamoyl)-N-tetradecanoyl tyramine for the inhibition of MCF-7 cell proliferation. Our data indicate the utility of (p-O-sulfamoyl)-N-alkanoyl tyramines for the inhibition of breast cancer cell estrone sulfatase activity. Furthermore, our data support the concept that nonsteroidal estrone sulfatase inhibitors may be useful as therapeutic agents for estrogen-dependent breast cancers.

Xanthomonas maltophilia peritonitis in uremic patients receiving continuous ambulatory peritoneal dialysis

Xanthomonas maltophilia peritonitis has been only occasionally reported in patients receiving continuous ambulatory peritoneal dialysis. We present a series of six cases of peritonitis caused by such bacteria, accounting for 1.5% of all peritonitis episodes encountered in our renal unit over the past 5 years. Recent bacterial peritonitis treated with broad-spectrum antibiotics was the major risk factor, and the outcome was poor with medical treatment alone. Secondary peritonitis, especially fungal, was common and probably related to the prolonged course of antibiotics. All patients eventually required removal of the catheter, either because the effluent failed to clear up or because of secondary peritonitis. We suggest that X maltophilia peritonitis be treated with double antibiotics as soon as it is diagnosed. To prevent the development of superimposed infection after prolonged administration of antibiotics, the Tenckhoff catheter should be removed if the peritonitis fails to respond to a short course of antibiotics.

Memory enhancement mediated by the steroid sulfatase inhibitor (p-O-sulfamoyl)-N-tetradecanoyl tyramine

The intent of this study was to determine whether altering the metabolism of neurosteroids via blockade of the enzyme, steroid sulfatase, could enhance memory retention in rats. The steroid sulfatase inhibitor p-O-(sulfamoyl)-N-tetradecanoyl tyramine (DU-14) was administered alone and in combination with the neurosteroid dehydroepiandrosterone sulfate (DHEAS) to rats which were then tested for the reversal of scopolamine-induced amnesia. A single 30 mg/kg IP dose of DU-14 produced a significant inhibition of steroid sulfatase activity in both brain (14.8%), and liver (85.2%) tissues, 24 hours following administration. In a passive avoidance test, DU-14 enhanced the reversal of amnesia by DHEAS. These results suggest that steroid sulfatase inhibition can potentiate the memory enhancing properties of DHEAS.

Enhancement of hippocampal acetylcholine release by the neurosteroid dehydroepiandrosterone sulfate: an in vivo microdialysis study

The effect of dehydroepiandrosterone sulfate (DHEAS) administered i.p. on the release of acetylcholine (ACh) from the hippocampus of anesthetized rats was examined using in vivo microdialysis. DHEAS significantly increased ACh release above the pre-treatment levels for all doses tested. The administration of 100 mg/kg significantly enhanced ACh release greater than 4-fold when compared to the saline-treated group 80 min following drug administration. This study is the first to demonstrate that the neurosteroid DHEAS, a negative allosteric modulator of the GABAA receptor, can enhance the release of ACh from neurons in the hippocampus.

Synthesis and sulfatase inhibitory activities of non-steroidal estrone sulfatase inhibitors

About one-third of breast cancers are classified as estrogen-dependent breast cancers. In the past 10 years, numerous reports have suggested the importance of estrone sulfate and estrone sulfatase in regulating the supply of estrogens to these cancers. Estrone sulfatase inhibitors may thus prove to be useful for the treatment of these diseases. Several research groups have reported the development of estrone sulfatase inhibitors, and estrone-3-O-sulfamate has been shown to be the most potent sulfatase inhibitor. However, a recent report indicated that estrone may be released during the inactivation of sulfatase by estrone-3-O-sulfamate and rendered the inhibitor to be estrogenic. Therefore, there is a need for a potent non-steroidal sulfatase inhibitor that is metabolically stable, more selective, and lacking estrogenic activity. We developed a series of (p-O-sulfamoyl)-N-alkanoyl tyramines, and they proved to be potent estrone sulfatase inhibitors. Using human placental microsome as the enzyme source, the best inhibitor in this series, compound 18, has an IC50 of 55.8 nM. Another potent inhibitor in this series, compound 17, exhibited time-dependent inactivation of sulfatase when incubated at various concentrations (0.2-1.0 microM) of the inhibitor. Estrone sulfate partially blocked the inactivation of the enzyme by the compound, indicating that the compound inactivated sulfatase at the active site. The irreversible nature of the enzyme-inhibitor interaction was supported by irreversibility studies. Thus, (p-O-sulfamoyl)-N-alkanoyl tyramines represent a new series of non-steroidal estrone sulfatase inhibitor.

Inhibition of placental estrone sulfatase activity and MCF-7 breast cancer cell proliferation by estrone-3-amino derivatives

Estrogen levels in breast tumors of post-menopausal women are as much as 10 times higher than in plasma, presumably due to in situ formation of estrogen. Several lines of evidence indicate that the major source of estrogen in breast cancer cells may be from conversion of estrone sulfate to estrone by the enzyme estrone sulfatase. Inhibitors of estrone sulfatase may thus be potential agents for the treatment of estrogen-dependent breast cancer. We designed and synthesized a series of estrone-3-amino derivatives as potential estrone sulfatase inhibitors. We tested the inhibitory potential of these compounds using human placental microsomes, which contain a substantial amount of estrone sulfatase activity. Several compounds in the series significantly inhibited estrone sulfatase activity of the human placental microsomes when present at 10 microM. The IC50 for the estrone-3-amino compounds ranged from 8.7 to 14.6 microM. We next tested the ability of the estrone-3-amino derivatives to inhibit growth of the estrogen-dependent MCF-7 breast cancer cell line. MCF-7 cells showed substantial proliferation in the presence of 100 nM estrone sulfate in estrogen-free media, indicating that the cells were capable of converting estrone sulfate into estrone. The proliferative effect of estrone sulfate (1 microM) was significantly blocked by the estrone-3-amino derivatives at 10 microM. The magnitude of MCF-7 cell inhibition resulting from treatment with the estrone-3 amino compounds was similar to or exceeded that of Danazol, but was less than the level resulting from treatment with estrone sulfamate. Using data from all of the compounds tested, inhibition of MCF-7 cell proliferation was positively correlated with inhibition of placental estrone sulfatase activity, suggesting that the reduction in cell growth was attributable to the blockade of sulfatase activity. In support of this, there was no relationship between inhibition of estrone sulfatase activity and inhibition of cell growth when the estrogen-independent cell line MDA-MB-231 was used. Our results indicate the possible utility of estrone-3-amino derivatives for inhibition of estrone sulfatase activity. Further, our data support the concept that estrone sulfatase inhibitors may be useful as therapeutic agents for estrogen-dependent breast cancers.

Neutrophil attractant protein-1 interleukin 8 and its autoantibodies in IgA nephropathy

Human neutrophil attractant protein-1/interleukin 8 (IL-8) has been shown to activate neutrophils to degranulate in vitro and to be a potent chemotactic agonist for neutrophils and lymphocytes in vitro and in vivo. There is accumulating evidence that neutrophils are involved in inflammatory injury in IgA nephropathy (IgAN). We studied the serum levels of IL-8 and its autoantibodies of the IgA or IgG class in 36 patients with IgAN in comparison with 31 healthy controls and 26 patients with other primary glomerulonephritides (CGN). Interleukin 8 was more frequently detected in sera of patients with IgAN and their serum levels were significantly higher than those of healthy controls. The free IL-8 autoantibodies of the IgA, but not IgG class, were more frequently detected in patients with IgAN and their serum levels were significantly elevated compared with both groups of controls. The complexed IL-8 autoantibodies of either class were not different among the three groups of subjects. Again the ratio of free to complexed IL-8 autoantibodies of the IgA class was raised in patients with IgAN. Histologic examination revealed increased polymorphs and monocyte/macrophage infiltration in IgAN compared with other glomerulonephritides. When the serum levels of IL-8 and IL-8 autoantibodies were compared between IgAN patients with milder pathology and those with more severe pathology, the latter group had significantly higher serum levels of free and complexed IL-8 autoantibodies of the IgA class. These observations suggest a possible role for IL-8 and its autoantibodies of the IgA class in the inflammatory process of IgAN. These autoantibodies may provide a clinically useful marker for the diagnosis of disease severity.

Transforming growth factor-beta mRNA expression in CD4+ T cells from patients with primary glomerulonephritides

Immunoreactivity to transforming growth factor-beta (TGF-beta) was detected in glomerular cells from patients with chronic glomerulonephritis, yet it remains uncertain whether the glomerular TGF-beta deposits reflect TGF-beta produced by the glomerular cells alone or from additional extrarenal origin. We examined the TGF-beta messanger RNA (mRNA) expression in circulating CD4+ T cells from 45 patients with different primary glomerulonephritides. By semiquantitative polymerase chain reaction, the TGF-beta mRNA expression was significantly raised in histopathologic entities characterized by increased mesangial proliferation or segmental sclerosis but not in histopathologic entities with little mesangial proliferation or sclerosis. These findings suggest that, other than TGF-beta produced de novo, TGF-beta from systemic source can also contribute to mesangial proliferation by binding to the glomerular cells after being filtered by the glomeruli. Increased TGF-beta gene expression in CD4+ T cells in these patients may potentially enhance glomerular injury.

Serologic study of immunoglobulin A-fibronectin aggregates in immunoglobulin A nephropathy

The immunoglobulin A (IgA)-fibronectin aggregates, detected by enzyme-linked immunosorbent assay using either antifibronectin or collagen I as binding protein, were previously found to be raised in the circulation of patients with IgA nephropathy (IgAN). It has been suggested that IgA-fibronectin aggregates are involved in the pathogenesis and that the plasma IgA-fibronectin level may even be of diagnostic value in IgAN. Nevertheless, a recent report has questioned the specificity of these assays as plasma IgA may interact with immobilized IgG and these assays detect not only IgA-fibronectin, but also total plasma IgA. These doubts render the interpretation of raised IgA-fibronectin aggregates in IgAN impossible. We isolated total IgA, in plasma by jacalin-agarose. Monomeric and polymeric IgA1 were distinctly separated by fast protein liquid chromatography. When the fast protein liquid chromatography fractions were analyzed for IgA-fibronectin using the antifibronectin capture assay, increased optical density values were predominantly observed in polymeric IgA but not in monomeric IgA. Similar findings were found when the fast protein liquid chromatography fractions were studied using a novel gelatin-anti-IgA assay that avoided nonspecific interaction between plasma IgA and immobilized IgG used as the capture antibody in antifibronectin capture assay. Using our gelatin-anti-IgA assay, we failed to demonstrate a diagnostic increase in IgA-fibronectin aggregates in polymeric IgA from patients with IgAN compared with controls. Our finding of circulating IgA-fibronectin aggregates in patients with IgAN comparable to those of healthy controls did not support the notion that these aggregates may have a pathogenetic role or diagnostic value in IgAN.

Anti-DNA autoantibodies stimulate the release of interleukin-1 and interleukin-6 from endothelial cells

The pathogenetic mechanism of vasculitis in systemic lupus erythematosus (SLE) remains a subject of debate. Evidence for a direct pathogenetic role of anti-double-stranded DNA antibodies (anti-dsDNA) is not strong. Supernatant concentrations of interleukin-1 beta and interleukin-6, and mRNAs encoding for interleukin-1 alpha and interleukin-1 receptor-1 were determined in cultured human umbilical vein endothelial cells (HUVEC), incubated with control IgG (n = 18), anti-dsDNA (n = 18), or IgG from the same lupus patient depleted of anti-dsDNA by affinity chromatography (anti-dsDNA-dep-IgG). Compared with control IgG, there was a significant increase of supernatant interleukin-1 beta and interleukin-1 alpha mRNA in endothelial cells incubated with anti-dsDNA. The supernatant interleukin-1 beta and interleukin-6, and mRNAs encoding for interleukin-1 alpha and interleukin-1 receptor-1, were significantly elevated in endothelial cells incubated with anti-dsDNA, compared with those incubated with anti-dsDNA-dep-IgG. Pretreating HUVEC with native DNA before incubating with anti-dsDNA did not result in an additive effect. These in vitro studies suggest that anti-dsDNA plays an important pathogenetic role in inducing inflammatory injury of vascular endothelium in SLE.

Increased binding of polymeric lambda-IgA to cultured human mesangial cells in IgA nephropathy

IgA nephropathy (IgAN) is characterized by raised plasma lambda-IgA1 and mesangial polymeric lambda-IgA1 deposits. It remains uncertain whether the predominant glomerular lambda-IgA1 deposits represent a selective uptake of polymeric IgA or a non-specific uptake due to elevated circulating lambda-IgA1 levels in response to an unidentified antigen. In this study, we explored whether there is an increased binding of monomeric IgA1 (mIgA1) or polymeric IgA1 (pIgA1) from patients with IgAN to cultured human mesangial cells (HMC). Total IgA1 in plasma from patients or healthy controls was isolated by jacalin-agarose column as jacalin-bound proteins (JBP). Monomeric IgA1 and pIgA1 were distinctly separated by FPLC. HMC were incubated with IgA preparations and IgA bound to HMC was determined by flow cytometry analysis using standard curves constructed by known concentrations of kappa-IgA1 or lambda-IgA1. In order to avoid any increased binding of IgA to HMC due to elevated kappa- or lambda-IgA concentrations in JBP samples from patients, JBP samples from patients or controls were appropriately diluted to achieve comparable levels of total IgA1. No differences in the total mIgA1 or pIgA1 concentration, percentage of mIgA1 or pIgA1, or the kappa/lambda ratio of mIgA1 or pIgA1 were found between adjusted JBP samples from patients or healthy controls. We found a sharp rise in percentage of pIgA1 among IgA1 bound to HMC (70%), despite the fact that only 3% of the IgA1 in the adjusted JBP samples were polymeric, suggesting that pIgA1 had a higher affinity to HMC than mIgA1. Furthermore, the kappa/lambda ratios of pIgA1 bound to HMC were significantly lower than the kappa/lambda ratios of pIgA1 in adjusted JBP only with IgAN patients but not healthy controls (P = 0.0026). Our data suggest a preferential mesangial binding of polymeric lambda-IgA1 from patients with IgAN. These polymeric lambda-IgA immune complexes are likely to be "pathogenic" and are important in the pathogenesis of IgAN.

Acute renal failure induced by angiotensin converting enzyme inhibitor in a patient with polyarteritis nodosa

We report a patient who presented with malignant hypertension and renal failure. He was treated with lisinopril, spironolactone, and nifedipine retard for blood pressure control. Subsequent renal function showed further deterioration, but it then improved after withdrawal of the angiotensin converting enzyme inhibitor (ACE I). The diagnosis of classical polyarteritis nodosa was established with aneurysmal dilatation demonstrable in the renal vasculature. His renal impairment improved further following immunosuppressive therapy and the disease has remained inactive 4 years after first presentation. This is the first reported case of acute renal failure associated with the use of ACE I in polyarteritis nodosa.

Alport's syndrome in monozygotic twins

Identical twins presented at the same time with renal failure. They also recalled a simultaneous history of "nephritis" as early as the age of 6 years. Renal biopsies revealed variably thickened glomerular basement membranes with the lamellation and splitting characteristic of Alport's syndrome. Bilateral sensorineural deafness was demonstrated in both twins on audiometric testing. A positive family history in the mother and one elder sister confirmed the diagnosis of Alport's syndrome. This is the first reported case of Alport's syndrome occurring in monozygotic twins.

Effect of renal transplantation on pulmonary function in patients with end-stage renal failure

Ten patients with end-stage renal failure on maintenance dialysis underwent serial lung function tests before and at monthly intervals after renal transplantation. Mean values of forced expiratory volume within 1 s, forced vital capacity, and total lung capacity were within the normal range before and up to 6, months after transplantation. The mean value of residual volume (RV) was above the normal range during all periods measured (157.8 +/- 21.5% predicted before transplantation and 121.2 +/- 17.0% predicted at 6 months after transplantation). No statistically significant changes in lung volumes were detected over a course of 6 months, but there was a trend for a reduction in RV after transplantation. The single-breath diffusion capacity for carbon monoxide (DLCO) was in the high-normal range before transplantation (115.7 +/- 9.5% predicted). It remained high at 1 month after transplantation (124.5 +/- 12.2% predicted), but it gradually came down to the normal range from the 2nd month onwards. At 6 months after transplantation the mean DLCO was 83.8 +/- 7.3% of predicted which was significantly (p < 0.0001) lower than the value before transplantation. We conclude that raised DLCO and RV values occurred in patients with end-stage renal failure on maintenance dialysis which were most likely the result of pulmonary vascular congestion, and these abnormalities tend to improve after renal transplantation.