Oxidation phenotyping in Chinese and Malay populations

1. Debrisoquine hydroxylation phenotyping was carried out in 97 Chinese and 97 Malay healthy volunteers. 2. No poor metabolizer was found in the Chinese population. Using a metabolic ratio antimode of 10.0, two poor metabolizers were present amongst the Malays studied.

Analysis of Coping Methods Reported by Returning RNs

To teach registered nurses in a baccalaureate degree program effectively, educators need to be knowledgeable of the various coping methods used by these re-entry students in response to academic and clinical stress. This article describes a study designed to identify coping methods of registered nurses enrolled in programs designed for beginning students in nursing and programs designed to build on prior nursing education.

Empty sella syndrome associated with central nervous system cysticercosis

A 55-year-old woman presented with severe recurrent headache accompanied by dizziness. The brain CT scan showed multiple low-density cystic lesions in the suprasellar and left sylvian cisternae with total empty sell syndrome. The communication between the cisternae and the suprasellar cyst was not verified on the metrizamide CT scan. Treatment with praziquantel resulted in headache inilially and a rise in specific IgG.

Treatment of a case of fulminant hepatic failure with continuous infusion of prostaglandin (PGE1)

Fulminant hepatic failure is a serious clinical syndrome with high mortality because of the limitation of therapeutic modality. However, survivors usually recover completely. Our experience with prostaglandin E1 (PGE1) treatment of a patient with acute fulminant viral hepatitis, who had a history of blood transfusion and immunosuppressive therapy for aplastic anemia, will be presented.

Stereoselective disposition of ibuprofen enantiomers in synovial fluid

The simultaneous disposition of the enantiomers of ibuprofen in synovial fluid and plasma was studied in eight patients with arthritis. Concentrations of the active S-enantiomer in synovial fluid exceeded those of the R-enantiomer at all times in all patients with the ratio of S to R concentrations being 2.1 +/- 0.3 (mean +/- SE). Synovial fluid concentrations fluctuated much less than in plasma and exceeded plasma concentrations from 5.4 +/- 0.3 hours for R-ibuprofen and 5.5 +/- 0.6 hours for S-ibuprofen. Pharmacokinetic analysis suggested that, although the enantiomers diffuse into synovial fluid primarily in the unbound form, there may be significant diffusion of the enantiomers out of synovial fluid in the protein-bound form in some patients. Interpatient differences in the disposition of the enantiomers of ibuprofen in synovial fluid were evident and may contribute to the interindividual variability in response to treatment with ibuprofen.

Iron deficiency in female athletes: its prevalence and impact on performance

The prevalence of iron deficiency and its impact on performance have not been adequately investigated in non-endurance athletes. This study evaluated these factors in 100 female intercollegiate athletes in various sports, and in 66 non-athletes. All subjects had determinations of hemoglobin, ferritin, and transferrin saturation. Athletes reported on diet, menses, and symptoms. Athletes and coaches described mood and performance. Iron-deficient athletes were treated with iron; others received placebo. The same data were collected at season's end. Initially 31/100 (31%) athletes had iron deficiency (ferritin less than 12 ng.ml-1; transferrin saturation less than 16%, or both) compared to 30/66 (45.5%) controls (not statistically significant). Compared to normal athletes, iron-deficient athletes did not have more symptoms of iron deficiency or differences in mood state, but they considered their performance to be worse (P less than 0.05). Their total iron intakes were similar, as were menstrual blood losses. At re-evaluation, 7/45 (15.6%) initially normal athletes were iron-deficient; 14/22 (63.6%) initially iron-deficient athletes were normal. Athletes receiving an iron supplement and their coaches did not report a greater improvement in performance or mood than athletes receiving a placebo. Female college athletes frequently had iron deficiency that could be successfully treated during the season, while some untreated normal athletes became iron-deficient. Iron deficiency and its treatment had no significant impact on symptoms or mood, but affected subjective assessment of performance.

Phase I and pharmacokinetic trial of carboplatin in refractory adult leukemia

Sixteen patients [13 acute nonlymphocytic leukemia (ANLL), 2 acute lymphocytic leukemia, 1 chronic myelogenous leukemia in a blast crisis; median age, 40 yr; range, 25-78 yr; 9 male, 7 female] received 23 courses of carboplatin given as a bolus on a daily X 5 schedule. Six patients were given 7 courses of carboplatin at 200 mg/m2/day; 3 patients received 5 courses at 250 mg/m2; 9 patients received 11 courses at 300 mg/m2; 2 patients initially treated at 200 mg/m2 were given their 2nd course at 300 mg/m2. Significant hearing loss documented by audiometry occurred in five patients, including three of nine treated at 300 mg/m2. All five had prior or recent exposure to aminoglycoside antibiotics. Three patients developed cancer and acute leukemia group B grade 3 or 4 mucositis, and 18 of 23 courses were complicated by nausea and vomiting. Marrows were hypocellular or aplastic in all patients treated at the highest dose. No complete responses occurred, although two patients with ANLL treated at 300 mg/m2 achieved partial responses lasting 71 and 138 days. The t1/2 alpha [half-life (t1/2)], t1/2 beta, and total body clearance of ultrafilterable platinum were comparable to those previously described by us in patients receiving bolus doses of carboplatin of 22-77 mg/m2/day X 5. Carboplatin has activity in ANLL.

The value of 10-minute posttransfusion platelet counts

Monitoring of platelet counts 1 hour after transfusion has become standard practice in most centers. In this study, platelet counts obtained 10 and 60 minutes after 48 platelet transfusions were compared. There was a close, linear relationship (r = 0.98) between these values over a wide range of posttransfusion counts, indicating rapid equilibration of transfused platelets. Ten-minute posttransfusion samples are easier to obtain and are convenient for both patients and medical staff.

Diurnal effects on debrisoquine hydroxylation phenotyping

A study was performed to show whether debrisoquine phenotyping could be performed as an overnight procedure. Phenotyping of 33 normal volunteers was carried out during the day and night. A good correlation was observed between the day- and night-time metabolic ratios, although wide variation was observed in 3 subjects.

Serial measurement of lymphocytotoxic antibody and response to nonmatched platelet transfusions in alloimmunized patients

Serial evaluations of lymphocytotoxic antibody (LCTAb) and responsiveness to random donor platelet transfusion were reviewed in 234 patients who had developed LCTAb at some time during their treatment course. Seventy (30%) of these patients had significant falls in antibody levels. In 44 patients these declines occurred after further antigenic exposure was reduced either because no transfusions were administered or only histocompatible platelets were transfused. Forty patients with declines in LCTAb levels who were previously refractory to platelet transfusion were rechallenged with random donor platelets. Thirty-four of 35 clinically evaluable patients had good responses to these unmatched transfusions for 2 weeks to 36 months, and in 21 patients antibody did not return despite repeated transfusions. Thus, serial LCTAb measurements are helpful in the management of alloimmunized patients. Many patients will have decreases or a loss of LCTAb, either permanently or transiently, and can be successfully supported with more easily available unmatched random donor platelet transfusions.

Minimally differentiated acute nonlymphocytic leukemia: a distinct entity

Ten of 136 consecutive adult patients with previously untreated acute leukemia had morphologically undifferentiated leukemia by light microscopy. Leukemic cells from these patients were characterized by agranular cytoplasm, negative histochemical staining with sudan black (SB) and nonspecific esterase, and absent lymphoid cell surface markers and therefore were not classifiable according to the French-American-British (FAB) system. Electron microscopy with myeloperoxidase (MPO) staining revealed the presence of peroxidase positive cytoplasmic granules and endoplasmic reticulum in eight of the nine patients studied. Cells from the patient who was negative for MPO were also negative for platelet peroxidase. A series of monoclonal antibodies to myeloid antigens also revealed myeloid features with all patients having at least one myeloid differentiation antigen present on the surface of their cells. Common acute lymphoblastic leukemia (ALL) antigen was absent in the nine patients tested. Cytogenetic analysis of blast cells was abnormal in seven patients on whom adequately banded chromosomes were obtained although there were no consistent abnormalities. No patient had a Ph1 chromosome. Only two of the ten patients achieved a complete remission. Morphologically undifferentiated leukemia may have myeloid features when studied by transmission electron microscopy or with monoclonal antibodies for cell surface markers. Such studies should be performed when the leukemia cannot be classified using either light microscopy or lymphoid cell surface markers. Such patients infrequently achieve remission with standard therapy and constitute a distinct entity.

Analysis of Stressful Clinical and Didactic Incidents Reported by Returning Registered Nurses

Although stress is an important issue for the returning or entry registered nurse, seldom is stress management discussed with students. This paper describes a study designed to identify and rank stressful clinical and didactic experiences of returning female registered nurses enrolled in baccalaureate degree nursing programs. A content analysis of critical incidents reported by these re-entry women is the focus of this paper.

Intravenous immune globulin for patients alloimmunized to random donor platelet transfusion

Immune globulin, prepared as a chemically and enzymatically unmodified solution in 10 percent maltose at pH 4.25, was administered intravenously, at a dose of 0.4 g per kg per day for five consecutive days, to seven alloimmunized patients who had acute nonlymphocytic leukemia. All patients had an approximately threefold rise in IgG level. Five patients showed no change in lymphocytotoxic antibody (LCTAb) activity and no response to random donor platelets that were administered after the immune globulin. The activity of LCTAb either disappeared or diminished after immune globulin infusion in two patients, and they had borderline acceptable corrected count increments 1 hour after transfusion of pooled random-donor platelet transfusions. Because of the diminished LCTAb activity, the improvements in response to pooled random-donor platelet transfusions cannot be ascribed to the administration of immune globulin. High-dose intravenous immune globulin has not been shown to be effective in reversing the effects of alloimmunization.

Clinical and cytogenetic features of familial erythroleukaemia

A family is described in which six members developed acute nonlymphocytic leukaemia (ANLL) over the past 15 years, all morphologically FAB M6. Five affected individuals (ages 54-73) are members of a single sibship, the sixth (age 31) was the son of one of the affected sibs. The family lives in a rural area, and no environmental hazard has been identified. One of the six patients never resided in the same geographic area as the others. Three patients with leukaemia died without chemotherapy, two died shortly after the initiation of chemotherapy and the most recent patient never achieved remission, surviving 10 months. Bone marrow specimens from the two most recent patients were analysed for cytogenetic abnormalities using chromosome banding techniques. In addition, skin fibroblasts were examined in a single patient. The fibroblasts had a normal karyotype. Bone marrow cells from both patients had complex abnormalities. Some similarities were observed, including: hypodiploidy; loss of one chromosome 20; the presence of multiple marker chromosomes. In each case one marker appeared to involve the 'missing' no. 20 with an alteration of the long arm--loss (20q-) in one patient and gain (20q+) in the other. Peripheral blood lymphocytes were grown in folate deficient medium, but no evidence for folate sensitive fragile sites was found. Marrow chromosomes from a third leukaemic sibling were examined without banding techniques in 1976 and the karyotype was 45,XY,-18,-F(19 or 20), +marker. No specific cytogenetic finding was common to the three patients studied except for the loss of an F group chromosome. This family is unique in the literature with six cases of familial leukaemia of the same morphologic subtype, and the cytogenetic findings suggest that loss or rearrangement of part of the long arm of a single chromosome 20 may have occurred in each of the three patients examined.

Effects of triple therapy on the progression of mesangial proliferative glomerulonephritis

Fifty-two pairs of patients with idiopathic diffuse mesangial proliferative glomerulonephritis entered a controlled 3-year prospective trial of a combination regimen of cyclophosphamide, dipyridamole and warfarin. In the treatment group proteinuria decreased significantly (p less than 0.01) and renal function remained stable, but in the control group there was no change in proteinuria and creatinine clearance (Ccr) decreased significantly (p less than 0.01). The time patients with renal impairment in the control group and those in the treatment group took to reach end stage renal failure was significantly different (6.1 years versus 8.9 years, p less than 0.02). Among the patients with IgA nephritis, those in the treatment group (n = 27) had stable renal function and a significant decrease in proteinuria (p less than 0.01) but in the control group (n = 21) there was a significant fall in Ccr (p less than 0.01) and rise in serum creatinine (p less than 0.02) with no change in proteinuria. Among 23 pairs of patients in the study who were matched for renal function and degree of glomerulosclerosis, those in the treatment group had stable renal function and decrease in proteinuria (p less than 0.01) whereas those in the control group had decreased Ccr (p less than 0.01) but no change in proteinuria.

Disposition of drugs in the elderly

Adverse drug reactions not only occur more frequently but are also of a more severe nature in the elderly. For warfarin and many of the psychoactive drugs, this is due mainly to an increased pharmacodynamic sensitivity to the actions of these drugs. For a number of other drugs, old age is associated with changes in their distribution and eventual elimination from the body. This increases the risk of a relative overdose during routine use of the drug. Such risks can be minimised by the judicious adjustment of the dosages of these drugs.

IgG and IgG subclass specific antibody responses to diphtheria and tetanus toxoids in newborns and infants given DTP immunization

To evaluate immune responses to diphtheria and tetanus toxoids in infants we used enzyme-linked immunosorbent assays to detect total IgG and specific IgG-1, IgG-2, IgG-3, and IgG-4 antibody. One group of infants received a newborn dose and subsequently received the usual three doses of DTP. A second group of infants received only the routine dosage at 2, 4, and 6 months of age. In sera acquired at birth, 6, and 9 months of age, there were no statistically significant differences between the two vaccine groups in IgG antibody responses to diphtheria or tetanus, or in IgG subclass tetanus-specific antibody responses. In individual children, tetanus-specific subclass responses were similar in pattern to that for total IgG tetanus antibody, i.e. each IgG subclass response appeared to be regulated by similar mechanisms in that child, but the regulation differed between children. In contrast to a prior study of pertussis immunity, maternally acquired antibody did not significantly affect immune responses to diphtheria or tetanus toxoid by 9 months of age. There was no discernible tolerance due to early tetanus or diphtheria immunization or to high levels of maternally acquired antibody.

Clinical evaluation of platelet concentrates stored for one to five days

There are no large-scale data available describing the increments obtained with platelet concentrates stored for varying durations. Platelet concentrates prepared by standard techniques were stored at 22 degrees C with horizontal agitation in PL-732 bags and administered to clinically stable, nonalloimmunized recipients known to respond well to random donor platelet transfusions. The platelet concentrates were stored in a mean volume of 65.0 mL (range 54-80 mL) with an average yield of .72 X 10(11) platelets per unit of platelet concentrates (N = 100 consecutive units). There was no significant deterioration of pH during storage. Mean corrected count increments ranged between 16,600 (N = 146 transfusions) after 1 day of storage to 13,300 (N = 34 transfusions) after 5 days of storage. Although these differences were statistically significant (P less than .003, analysis of variance), the overall deterioration in increments was quite modest. Platelet concentrates can be stored under standard conditions for 1 to 5 days with acceptable clinical results.

Glomerulonephritis in Singapore: an overview

The pattern of glomerulonephritis (GN) consisting of 1057 renal biopsies is presented. Primary GN accounted for 91% and secondary GN 9% of which the commonest is lupus nephritis. Asymptomatic haematuria and proteinuria was the commonest mode of presentation (41%), gross haematuria 9%, nephrotic syndrome 29% while 5.5% presented with renal impairment and 4.3% with hypertension. Mesangial proliferative GN is the commonest histopathological lesion forming 66% of all primary GN. Minimal Lesion, Focal Global Sclerosis and Focal Segmental Glomerulosclerosis accounted for 7% each. Membranous GN was uncommon (3%) while Mesangiocapillary GN, Diffuse Endocapillary GN and Crescentic GN were even rarer. If the presenting feature was asymptomatic haematuria and proteinuria the likely diagnosis was IgA nephritis, and, if nephrotic syndrome it was likely to be Idiopathic Mesangial Proliferative GN but with negative staining on immunofluorescence. The course and prognosis of the various forms of GN are next discussed. Nephrotic syndrome with Minimal Lesion has an excellent prognosis while Crescenteric GN usually carries a grim prognosis. Finally, factors affecting the progression of IgA nephritis, the commonest form of GN occurring in Singapore are examined. Patients who developed renal failure ran two different courses; one was a slowly progressive course over an average of 7.7 years before reaching end stage renal failure (ESRF), while the other was a more rapid decline to ESRF within an average of 3.3 years where severe uncontrolled hypertension seemed to be the major adverse factor. 9% had renal impairment at the end of a follow up of 50 + 1/2 - 34 months while 5% progressed to ESRF. The cumulative renal survival was 91% after 6 years with no further loss up to 14 years. Unfavourable long term prognostic indices were proteinuria of more than 2 gms, hypertension, crescents on renal biopsy, severe segmental sclerosis and medial hypertrophy of blood vessels.

Protein selectivity in IgA nephropathy

The protein selectivity index was measured in 68 patients (53 males, 15 females) with proteinuria due to IgA nephropathy to determine whether it bore any relationship to other clinical and pathological features of known prognostic significance. The mean age of the patients was 25 +/- 8 years with a follow-up period of 42 +/- 35 months. Forty-six presented with asymptomatic haematuria and proteinuria, 17 with macroscopic haematuria and 5 with the nephrotic syndrome. Twenty-three (34%) patients had selective proteinuria and 45 (66%) had non-selective proteinuria. Patients with non-selective proteinuria had more glomerulosclerosis (29% +/- 20 vs. 16% +/- 20, p less than 0.02), higher serum creatinine (1.47 mg/dl +/- 0.70 vs. 1.17 mg/dl +/- 0.33, p less than 0.02), lower creatinine clearance (79 ml/min +/- 28 vs. 95 ml/min +/- 25, p less than 0.02), and higher incidence of hypertension (chi 2 = 3.84, p less than 0.05) when compared to those with selective proteinuria. The protein selectivity was measured at the end of the study. Of the 5 patients with the nephrotic syndrome, 1 had poorly selective proteinuria and failed to remit and 4 had highly selective proteinuria who either remitted spontaneously (1 patient) or with treatment (3 patients). The results suggest that patients with IgA nephropathy and poorly selective proteinuria are more likely to have other features indicating a poor prognosis such as glomerulosclerosis, renal impairment and hypertension.

Diaziquone given as a continuous infusion is an active agent for relapsed adult acute nonlymphocytic leukemia

Diaziquone given as a bolus has not been effective in patients with relapsed or refractory leukemia. Because of in vitro data suggesting enhancement of diaziquone-induced cytotoxicity for human and murine leukemia cells with increased duration of drug exposure and the relatively short terminal plasma half-life of diaziquone, 49 patients (34 acute nonlymphocytic leukemia [ANLL], six chronic myelogenous leukemia in blast crisis [CML-B], five acute lymphocytic leukemia [ALL], four 2 degrees ANLL) with leukemia were given diaziquone as a continuous infusion for seven days. The maximum tolerated dose was 28 mg/m2/d for seven days. The dose-limiting toxicity was the duration of bone marrow aplasia (median, 49 days to greater than 500 PMNs in responders; range, 28 to 101 days). Nonhematologic toxicity was minimal. Responses occurred only in patients with relapsed ANLL, of whom 26 were treated at effective doses. There were six complete responses (CR) (23%) and two partial responses (PR) (8%), although five of eight responders never achieved platelet counts greater than 100,000/microL. Thrombocytopenia in these patients was felt to be a manifestation of diaziquone effect, not persistence of leukemia. The median duration of CR was 195 days (range, 88 to 860+). One patient had active CNS leukemia at the start of treatment and has had a durable (28+ month) CR in both sites of disease. Diaziquone produced prolonged aplasia in patients with secondary ANLL and CML-B (five of ten patients died aplastic), whereas patients with ALL all had regrowth of leukemia and two failed to become aplastic. The lack of significant nonhematologic toxicity and the activity in patients with relapsed ANLL render diaziquone of interest as second-line therapy or consolidation therapy in first remission for patients with ANLL.

Paralytic shellfish poisoning in Singapore

Paralytic shellfish poisoning is caused by the ingestion of shellfish meat rendered toxic by exposure to a high level of toxic dinoflagellates during the phenomenon of "red tide". This paper reports the first outbreak of paralytic shellfish poisoning from green mussels in Singapore which resulted in two deaths. Analysis of the mussel meat by a standardised mouse bioassay confirmed the presence of the toxin. An attempt was also made to extend the bioassay to an analysis of the gastrointestinal contents. The clinical features of the condition are presented.

Antithrombin III in mesangial IgA nephritis

Plasma Antithrombin III (A T III) was measured in 97 patients with IgA nephritis, 30 patients with non IgA idiopathic mesangial proliferative glomerulonephritis and 40 healthy subjects. The mean plasma A T III levels in the patients with IgA nephritis (105 +/- 10%) was significantly higher than those of normal controls (96 +/- 5%) (p less than 0.0005). The mean plasma A T III levels in the patients with non IgA nephritis (101 +/- 10%) was not different from those of the normal controls or the patients with IgA nephritis. A T III levels were significantly correlated with proteinuria (p less than 0.0001), segmental sclerosis (p less than 0.001), crescents (p less than 0.01), medial hypertrophy (p less than 0.001) and intensity of IgA staining on IMF (p less than 0.02). Patients with IgA nephritis with raised A T III levels had significantly more proteinuria (p less than 0.003), more segmental sclerosis (p less than 0.007) as well as a greater intensity of IgA staining on IMF (p less than 0.02) when compared to patients with normal A T III levels. The data suggest that raised plasma A T III levels may serve as a prognostic marker in IgA nephritis.

Evidence for rapid mobilization of platelets from the spleen during intensive plateletpheresis

The role of the spleen as a reservoir capable of adding platelets to the circulating blood cells has been well documented in animals but poorly documented in humans. As part of a program of platelet cryopreservation, we have intensively plateletpheresed a group of patients with acute leukemia in remission who had undergone splenectomy. The results of the 64 plateletphereses in these 11 patients (average platelet yield 4.2 X 10(11) +/- 2.4, range 1.2-12.4) were compared with 50 consecutive plateletphereses in nonsplenectomized leukemia patients (average yield 4.9 X 10(11) +/- 3.2, range 2.1-18.3) and 50 consecutive plateletphereses in normal donors (average yield 3.8 X 10(11) +/- 1.4, range 1.7-7.6). There was no difference in the prepheresis platelet counts among the three groups. Plateletphereses were done in 1.5-3 hr by intermittent flow differential cell centrifugation technique. The expected platelet yield was calculated by multiplying the pre-platelet count - (pre-hct/post-hct X post plt count) by the estimated blood volume (70 ml/per kg body weight). The mean ratios of the observed platelet yield to expected platelet yield were similar for the nonsplenectomized leukemia patients (mean ratio = 1.32 +/- 0.50, range 0.73-3.04) and normal donors (mean ratio = 1.31 +/- 0.49, range .52-2.9), implying mobilization of platelets from outside of the blood pool. In contrast, in the splenectomy group, the mean ratio (0.76 +/- 0.32, range 0.31-2.9) was significantly lower (p less than .001). These data indicate that there is replenishment of the circulating platelet pool by the spleen in response to the rapid removal of platelets.

Antithrombin III in renal transplant recipients

Antithrombin III (AT III) is increased in situations where there is increased platelet turnover. Plasma AT III levels measured in 39 renal transplant recipients were significantly higher than in 20 healthy subjects (p less than 0.001) and 20 patient controls (p less than 0.025). AT III levels were significantly correlated with the patients' platelet counts (r = 0.4, p less than 0.02). Transplant patients with less than 1 year follow up had significantly higher AT III levels than patients with more than 1 year follow up (p less than 0.01). All 5 patients with transplant rejection in the study had elevated plasma AT III levels. The data suggest that elevation of plasma AT III may be related to graft rejection.

Stereoselective disposition of ibuprofen enantiomers in man

This study has examined the stereoselective disposition of the enantiomers of ibuprofen in four healthy male subjects following separate administration of racemic ibuprofen (800 mg) and of each enantiomer (400 mg). A mean of 63 +/- 6% of an administered dose of R(-) ibuprofen was stereospecifically inverted to the S(+) enantiomer. There were no measurable inversion of the S(+) to R(-) ibuprofen. The kinetics of the individual enantiomers were altered by concurrent administration of the respective optical antipode. It is likely that this change reflects an interaction between the enantiomers at plasma protein binding sites. It was found that formation of ester glucuronide conjugates stereoselectively favoured the S(+) enantiomer. The data have demonstrated that the pharmacokinetics of ibuprofen and other alpha-methylarylacetic acids cannot be interpreted adequately without studying the pharmacokinetics of the individual enantiomers.

Effects of hemodialysis and peritoneal dialysis on antithrombin III and platelets

Plasma antithrombin III (AT III) levels in hemodialysis patients, low prior to dialysis, improved after dialysis (p less than 0.01). The platelet counts before and after dialysis, did not change significantly. In peritoneal dialysis patients the AT III levels, which were normal before dialysis, increased significantly after dialysis (p less than 0.01). The platelet counts before and after peritoneal dialysis also improved (p less than 0.005). No correlation was found between AT III levels and platelet counts. Although platelet damage has a contributory role in increasing AT III levels during hemodialysis, the data on peritoneal dialysis suggest that there may be other factors affecting platelets and AT III during dialysis.

Beta-2-microglobulin in the assessment of renal function of the transplanted kidney

Plasma and urine beta-2-microglobulin (B2m) were measured in 37 renal transplant recipients and 34 healthy subjects. Serum B2m was found to be a more sensitive index of renal function than serum creatinine. Renal transplant recipients had significantly higher urine B2m when compared with normal controls. Normal subjects had a higher serum to urine B2m ratio (SUR) while those with renal impairment had a lower SUR. Serum B2m used alone or together with urine B2m and SUR appears a useful index for assessment of renal allograft function as well as detection of potential renal damage.

Liquid chromatographic determination and plasma concentration profile of optical isomers of ibuprofen in humans

A sensitive and specific high-performance liquid chromatographic assay for the optical isomers of ibuprofen in plasma is reported. The isomers were converted to their diastereoisomeric S(+)-2-octyl esters and were resolved with two silica columns in series and a mobile phase containing 0.05% isopropyl alcohol in heptane. The lower limit of sensitivity was 0.5 micrograms/mL. The plasma concentrations of the optical isomers in a normal volunteer following administration of racemic, S(+)-, and R(-)-ibuprofen are reported. Following administration of R(-)-ibuprofen, there was stereoselective inversion of R(-)- to S(+)-ibuprofen.

High-dose intravenous gammaglobulin in alloimmunized platelet transfusion recipients

High-dose intravenous gammaglobulin (polyvalent immunoglobulin G) has been shown to be of benefit in some patients with immune thrombocytopenic purpura (ITP), possibly by producing reticuloendothelial system blockade. We studied this approach in patients refractory to random donor platelet transfusion using an IV IgG preparation manufactured by the Swiss Red Cross. Eleven adult patients with acute leukemia received either 0.4 g IgG/kg/d intravenously X five days (four patients) or 0.6 g/kg/d X five days (seven patients). All patients had high levels of lymphocytotoxic antibody and poor responses to random donor platelets. Except for mild headaches in two patients, there were no side effects related to the IgG infusions. All patients had significant elevations of serum IgG on the day after completion of treatment. Either random donor or partially HLA-matched platelet transfusions were administered the day after and, in some cases, during the IgG therapy. No patient had an improvement in one hour posttransfusion platelet count increments. Two additional patients received pooled platelet concentrates incubated for 30 minutes at 37 degrees C with IgG at a final concentration of 3 g% prior to transfusions. These results indicate that high-dose IgG, an extremely expensive treatment, cannot be recommended for alloimmunized adults with leukemia.

Expression of xenotropic-like env RNA sequences in normal DBA/2 and NZB mouse tissues

Using a DNA probe prepared from cloned env gene sequences of Friend spleen focus-forming viruses, we detected the differential expression of multiple RNA species in uninfected DBA/2 fibroblasts and in various tissues from adult DBA/2 and NZB mice. The size of the major RNA species detected was estimated to be 24S . The 24S RNA species was enriched in polyadenylate-selected preparations and thus may represent a message for endogenous viral envelope glycoproteins. The viral origin of the 24S RNA was further characterized by its hybridization to DNA probes containing the long terminal repeats of Harvey murine sarcoma virus, mouse mammary tumor virus, or the U3 region of an endogenous xenotropic virus. Although the env-related 24S RNA failed to react with either Harvey murine sarcoma virus or mouse mammary tumor virus long terminal repeat probes, it hybridized well with the xenotropic virus long terminal repeat probe. Therefore, it is likely that the RNA detected with the Friend spleen focus-forming virus env probe reflects transcription of xenotropic envelope sequences in uninfected tissues. Our finding that the level of 24S RNA varied in different organs indicated some tissue specificity in the expression of these xenotropic-like env proteins.

Persistence of interferon action in mouse cells permeabilized with lysolecithin

DNA synthesis, as measured by incorporation of [(3)H]TTP, was inhibited in Swiss mouse 3T3 cells treated with interferon and subsequently permeabilized with lysolecithin. The degree of inhibition observed was similar in intact or permeabilized cells. The interferon-induced antiviral state was retained in permeabilized cells.

Haematological and serum chemistry profiles of ferrets (Mustela putorius furo)

Female, male and castrated male ferrets were studied. Weight gain plateaued at 28 weeks of age with males about 500 g heavier than females. No statistically significant differences in haematology were observed with age, but alkaline phosphatase and alanine aminotransferase levels fell while glucose increased. Haemolysis led to various changes including marked increases in total protein, albumin, inorganic phosphate and sorbitol dehydrogenase.

A simple pharmacokinetic method for separating the three acetylation phenotypes: a preliminary report

1 Until recently, phenotyping the N-acetyltransferase enzyme had been restricted to distinguishing the slow acetylators from the rapid. Further separation of the heterozygous rapid phenotype from the homozygous rapid phenotype has only been possible by detailed pharmacokinetic studies using sulphadimidine and necessitating prolonged plasma sampling. 2 A simple method of deriving the basic pharmacokinetic parameters is presented. In this study of ten healthy volunteers, one urine sample and hourly plasma sampling over only 5 h enabled calculation of the total body (TBC) and metabolic clearances (MC) wih enough accuracy to distinguish the three (slow, intermediate and rapid) acetylator phenotypes. The spread of the distribution for the elimination rate constant was however too wide to enable their clear separation.

Acute renal failure--current concepts

The appalling mortality of acute renal failure in casualties in the Second World War has been reduced considerably by a better understanding of the clinical manifestations and improved therapeutic techniques which include early dialysis, better resuscitation measures, and maintenance of high urine flows in the high risk patients. The role of nephrotoxic antibiotics and other nephrotoxins especially radiographic contrast media, is increasing in importance. Non-oliguric acute renal failure is now a well documented clinical entity and although the mechanisms responsible for acute renal failure are still far from settled, the spectrum of acute renal failure in terms of clinical setting, predisposing factors and clinical features have changed since acute renal failure was first described.

Histopathological profile of adult nephrotic syndrome in Singapore

The renal biopsies of 100 patients presenting with the Nephrotic Syndrome were analysed. Eighty-seven percent were due to primary glomerulonephritis and the other 13% due to secondary glomerulonephritis of which Systemic Lupus Erythematosus was the commonest. Diffuse mesangial proliferative glomerulonephritis (DPGN) formed the largest group (60%). Minimal lesion occurred in 15% of patients and only 5% had Membranous Glomerulonephritis. 63% of patients with DPGN had negative staining on immunofluorescence. Even though Mesangial IgA Nephritis is prevalent in Singapore, it accounted for only 4% of glomerulonephritis causing the Nephrotic Syndrome.

Paraquat poisoning - management and prognosis

Paraquat poisoning has become a significant clinical problem since the early 1960s. Its high mortality has posed a major challenge to clinicians treating these patients. Two patients who survived and one who did not are reported. The management of these patients and the possible factors affecting their outcome are discussed.