Lung ultrasound is a promising screening tool to rule out interstitial lung disease in patients with rheumatoid arthritis

BACKGROUND AND OBJECTIVE

It is still controversial how to screen for interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA). We aimed to evaluate the performance of lung ultrasound (LUS) as a screening tool for RA-ILD and to compare it with the performance of chest auscultation, chest x-ray and pulmonary function tests (PFTs).

METHODS

Cross-sectional study of consecutive RA patients evaluated at a Rheumatology Clinic in Buenos Aires between January and December 2022. High-resolution computed tomography (HRCT) was the gold standard for diagnosing ILD and was performed within 30 days of the LUS, chest x-ray and PFTs. Investigators were blinded to HRCT results and patients' clinical data. LUS was performed by exploring 14 areas and was considered positive when the sum of B lines was ≥5. Performance for the diagnosis of ILD was reported for each diagnostic test.

RESULTS

One hundred and six patients were included; 87 (82%) were women. Median age was 60.9 (±9.5) years-old. A total of 32 (30.2%, 95% CI: 21.6%-39.9%) had ILD. The sensitivity and negative predictive value of LUS were 90.6% (95% CI 75.0%-98.0%) and 94.7% (95% CI 85.4%-98.9%), respectively. LUS performance was superior to that of the other evaluated diagnostic tests for screening ILD.

CONCLUSIONS

Given that the US is a low-cost point-of-care tool with a high negative predictive value, it is emerging as a valuable tool for ruling out ILD in patients with RA.

Pragmatic observations from a post-COVID-19 cardiac evaluation register: prevalence of cardiological alterations from a basic diagnostic sequence and contribution of the clinical hystory

Introduction

The prevalence of cardiological sequelae in patients recovered from COVID-19 varies in different reports. This may be due to the population diversity studied or to the complementary methods on which the diagnosis was based.

Objective

1) To determine the prevalence of “de novo” cardiological alterations (DN) in the population recovered from COVID-19 using a basic cardiological evaluation sequence. 2) To evaluate the contribution of the clinical history (CH) in the detection of DN.

Methods

Patients (pts) with COVID-19, PCR (+) were included. The pts attended an ambulatory consultation office at least 30 days after discharge from COVID-19. The evaluation was performed in a stepwise manner: first Interview: CH, physical examination (PE), and EKG; second Interview: routine laboratory test, C-reactive protein, echocardiogram and cardiac biomarkers. Other complementary studies (Holter, RMI, CCG) were requested according to previous findings. The diagnosis of DN (by PE, EKG or echocardiogram, alone or with the addition of other methods) was defined as the appearance of cardiological alterations in patients with no pre-existing known heart disease or the progression of a known cardiac disease. The prevalence of DN is described. Sensitivity, specificity and predictive value of CH for DN are reported.

Results

A total of 246 pts were evaluated with the first interview (age: 52±13 years; women: 47.8%; caucasian: 60.6%; overweight: 79%; some pathological history: 71.5%; previous heart disease: 15.4%; hospitalization during the acute phase of COVID: 78.8%; mild Covid: 37%, moderate: 39%, severe: 24%; time between discharge and post-COVID evaluation: 68±42 days). DN were detected in 62 pts: rhythm disturbances: 41 (sinus tachycardia: 23 (18 isolated), sinus bradycardia: 3, supraventricular arrhythmia: 6, ventricular arrhythmia: 14); conduction disturbance: 10, ventricular dysfunction: 20 (12 de novo, 8 progression). Specific diagnoses: myocarditis: 6, coronary artery disease: 5, acute mitral insufficiency: 1. In 16 pts (6.5%) DN had clinical relevance. Six of them (2.4%) required hospitalization. In previously healthy pts with mild COVID, only rhythm disorders were detected in 3 pts. Se, Sp and PV of the CH is shown in Table 1. Eighteen Holter monitoring tests (5 +), 9 MRIs (5 +), 4 CCGs (2 +) were performed.

Conclusions

1) Using a basic cardiac diagnostic sequence, at least 30 days after discharge, a quarter of post-COVID patients had “de novo” cardiological findings. However, a small percentage became clinically relevant. The causal relationship of DN with COVID-19 cannot be unequivocally asserted. Previously healthy patients have low prevalence of cardiac findings detected with a basic diagnostic sequence.

2) The data obtained from the clinical history have a low positive predictive value.

Funding Acknowledgement

Type of funding sources: None.

Prognostic value of static and dynamic biomarkers in COVID-19 patients: a prospective cohort study

OBJECTIVE

The aim of this study was to analyze in a prospective cohort of hospitalized COVID-19 patients the relationship between biomarkers levels and their variation within the first 4 days since admission, and prognosis.

METHODS

Prospective cohort study. Individuals with confirmed diagnosis of covid-19 admitted in our hospital were included. Blood samples were obtained systematically on days 1 and 4 of hospitalization. Levels of RCP, LDH, Ferritin and D-dimer, together with platelets, lymphocytes and neutrophils counts were measured. A combined outcome that included ICU admission and death was considered the primary outcome. Logistic regression analysis was performed.

RESULTS

We included 335 patients with confirmed COVID-19. During their hospitalization, 23 (6.8%) needed ICU admission, and 10 (2.9%) died. In the multivariate analysis, a value of RCP greater than 10 mg/dl (OR 8.69, CI95% 1.45-52), an increase in RCP greater than 20% (OR 26.08, CI 95% 3.21-211.3), an increase in LDH greater than 20% (OR 6.29, CI 95% 1.84-21.44), a count of lymphocytes lower than 1500/mm3 (OR 2.74, CI 95% 1.04-7.23), a D-dimer value greater than 550 ng/ml (OR 9.8, CI 95% 1.78-53.9) and a neutrophil/lymphocyte index greater than 3(OR 4.5, CI 95% 1.43-14.19) were all associated with the primary outcome.

CONCLUSIONS

Our study shows that the utilization of static and dynamic biomarkers may represent an important tool to assess prognosis of COVID-19 patients.

FRI0056 LUNG COMPROMISE SCREENING IN PATIENTS WITH EARLY RA. A MULTICENTRIC CROSS SECTIONAL STUDY

Background:

Rheumatoid arthritis (RA) affects 0.4-1.3% of general population (1). It can affect lungs in different ways, with interstitial lung disease (ILD) as the most severe. Clinically evident ILD has been reported in 10-42% of patients, with a great impact in prognosis (2).

Objectives:

Toidentify the prevalence of lung involvement in early rheumatoid arthritis patients (ERA) without previous known lung disease and describe the association between high resolution computed tomography (HRCT), lung functional tests (LFT) and clinical findings.

Methods:

Cross sectional multicentric study. We included ERA patients (1 year or less since diagnose) consecutively. Patients with previous RA related lung disease or biologic/targeted synthetic Dmard treatment were excluded. HRCT, immunological tests (rheumatoid factor, anti-CCP, ANA), LFT and clinical evaluation were performed.

Results:

We included 74 patients, 63 (85,1%) woman, mean (SD) of 47 (17,7) years. Thirty-seven patients (50%) were current or former smokers. Abnormal findings in HRCT were found in 62 patients (88,6%): ILD in 6 (8,6%), airway involvement in 40 (70%) and emphysema in 7 (10%). Ten patients (13,5%) had abnormal auscultation (2 sibilances, 2 roncus, and 6 crackles). Six patients (8,1%) had digital clubbing. Regarding immunological tests, 54/61 (88,5%) patients were positive for Anti CCP, and 53/61 (86,9%) were positive for FR. We compared features of patients with findings related to RA in HRCT (interstitial and/or airway) with those without them. We found no differences in the mean (SD) of DAS-28 [4,74 (1,38) vs 4,32 (1,39); p= 0,27]. The prevalence of anti- CCP was not higher in patients with abnormal HRCT [38/44 (86,3%) vs 16/17 (94,1%); p=0,39]. Patients with abnormal HRCT were older [median (IQR) 50,5 years (44,5-59,5) vs 43 years (32-51); p=0,008) and showed higher VSG values [mean (SD) 39,09 (24,03) vs 27,38 (17,6); p= 0,043]. Abnormal physical examination or dyspnea (class 2 mMRC or higher) was significantly associated with HRCT abnormalities [26 (50%) vs 3 (13,6%); p=0.003) and the presence of ILD on HRCT was significantly associated with crackles on the auscultation [4/68(6,25%) vs 2/6 (33,33%); p 0,023].

Conclusion:

This study shows a high prevalence of lung involvement in ERA patients of less 1 year from diagnosis. Also, we showed a significant association between HRCT and physical examination findings. This data highlights the importance of the clinical examination in Rheumatoid Arthritis patients. More studies with bigger samples and longitudinal follow up are needed to confirm and complete our results.

References:

[1]Rooney BK, Silman AJ. Epidemiology of the rheumatic diseases. Curr Opin Rheumatol [Internet]. 1999 Mar [cited 2016 Jul 19];11(2):91–7. Available from:http://www.ncbi.nlm.nih.gov/pubmed/10319210.

[2]Antin-Ozerkis D, Evans J, Rubinowitz A, Homer RJ, Matthay RA. Pulmonary Manifestations of Rheumatoid Arthritis. Clin Chest Med [Internet]. 2010;31(3):451–78. Available from:http://dx.doi.org/10.1016/j.ccm.2010.04.003.

Disclosure of Interests:

None declared

Pre-treatment plasma proteomic markers associated with survival in oesophageal cancer

Background:

The incidence of oesophageal adenocarcinoma is increasing worldwide but survival remains poor. Neoadjuvant chemotherapy can improve survival, but prognostic and predictive biomarkers are required. This study built upon preclinical approaches to identify prognostic plasma proteomic markers in oesophageal cancer.

Methods:

Plasma samples collected before and during the treatment of oesophageal cancer and non-cancer controls were analysed by surface-enhanced laser desorption/ionisation time-of-flight (SELDI-TOF) mass spectroscopy (MS). Protein peaks were identified by MS in tryptic digests of purified fractions. Associations between peak intensities obtained in the spectra and clinical endpoints (survival, disease-free survival) were tested by univariate (Fisher's exact test) and multivariate analysis (binary logistic regression).

Results:

Plasma protein peaks were identified that differed significantly (P<0.05, ANOVA) between the oesophageal cancer and control groups at baseline. Three peaks, confirmed as apolipoprotein A-I, serum amyloid A and transthyretin, in baseline (pre-treatment) samples were associated by univariate and multivariate analysis with disease-free survival and overall survival.

Conclusion:

Plasma proteins can be detected prior to treatment for oesophageal cancer that are associated with outcome and merit testing as prognostic and predictive markers of response to guide chemotherapy in oesophageal cancer.

Successful Management of Intrauterine Twin and Concomitant Cervical Pregnancy: A Case Report

Use of in vitro fertilization techniques increases the frequency of pathological implantation. However, simultaneous pregnancies are a rarity. Ectopic implantation of the embryo may occur in the cervical canal. This is the first case report, which describes successful management of an intrauterine twin pregnancy which occurred simultaneously with a cervical pregnancy. Diagnostic and therapeutic options are discussed along with the outcome of pregnancies. The cervical pregnancy was removed by aspiration, without dilation of cervical canal, which saved the lives of intrauterine fetuses and preserved fertility for following pregnancies. Finally we review the advanced methods in the literature.

The effects of postmenopausal hormone replacement therapy on hemostatic variables: a meta-analysis of 46 studies

The aim of the study was to summarize and reanalyze all available data from the literature to study the overall effect of postmenopausal hormone replacement therapy (HRT) and its various forms on hemostatic variables. Studies were identified from literature searches by Medline and Index Medicus, review articles and personal communications. Reference lists of all articles were checked to find additional studies. Principal investigators were contacted and asked to provide additional data if required. Data were collected separately for each factor of the hemostatic system. Studies written in any language were included. Each collection of studies was analyzed using standard methods for meta-analysis. A total of 76 arms of 48 studies were eligible for analysis. This included 6,119 women using HRT and 24,974 non-users. The age of investigated women was 40-68 years. HRT was associated with significantly decreased levels of fibrinogen, factor VIII, antithrombin III, and proteins C and S, but significantly increased plasminogen levels. HRT with estrogen alone or in combination with progestins, oral vs. transdermal regimens, different estrogen preparations and various progestins induced significantly different changes in many cases. In conclusion, HRT was associated with changes that could explain the increased rate of venous thrombotic events, and also with some changes that could account for beneficial vascular effects. Surprisingly, the addition of progestins induced favorable changes in many cases. Also, transdermal use was associated with more beneficial effects than oral regimens in some cases.

Clinical importance of vascular LH/hCG receptors--a review

It was believed for a long time that functional LH/hCG receptors were present only in gonads. Recent studies have demonstrated, however, that these receptors are also present in several nongonadal organs in the human body. Uterus is one of them. Besides two uterine layers, endothelial cells and smooth muscle of blood vessels in the uterus also contain these receptors. In vivo administration of hCG decreased vascular resistance in the human uterus and in vitro treatment increased vasodilatory and decreased vasoconstrictive eicosanoids in the vessels. These findings led us to investigate whether hCG administration to patients with signs of threatened abortion has any beneficial effect. Patients were treated with either magnesium or progesterone and/or hCG. The results showed that the frequency of patients reaching second trimester was higher when hCG was used, which was paralleled by a significant decrease in uterine vascular resistance. Patients who reached term after treatment had decreased incidence of preterm delivery and intrauterine growth retardation. In conclusion, we suggest that uterine vascular LH/hCG receptors play an important role in the peri-implantation period by increasing uterine blood flow through vasodilatation and also perhaps through angiogenesis and trophoblast invasion, resulting in therapeutic benefit.

[Increased fetal risk of primary venous thrombosis presenting at a young age]

Based on the hypothesis that the predisposition to thrombosis in women suffering from deep venous thrombosis at young age can disturb also the uteroplacental circulation, the authors retrospectively analyzed the fetal outcome of 333 pregnancies in 101 women with thromboembolic event before 40 years of age and compared it to the fetal outcome of 2943 pregnancies in 1000 randomly selected obstetrical patients without thrombosis. The relative risks of adverse fetal outcomes in thromboembolic women were as follows: 1.85 (95% C.I.: 1.35-2.55) for the spontaneous miscarriage, 3.9 (95% C.I.: 2.20-6.93) for the second-trimester miscarriage, 1.74 (95% C.I.: 1.15-2.64) for the low birth weight, 2.82 (95% C.I.: 1.28-6.30) for the perinatal loss and 7.17 (95% C.I.: 2.64-19.47) for the abruption of placentae. Data obtained suggest that women with deep venous thrombosis at young age should encounter a higher risk of the uteroplacental thrombosis which results in increasing fetal morbidity and mortality during the second and third trimesters of gestation.

Postmenopausal hormone replacement therapy and cardiovascular mortality in Central-Eastern Europe

BACKGROUND

The leading cause of death among elderly women is cardiovascular (CV) disease in the United States and in Western Europe as well. The protective effect of postmenopausal hormone replacement therapy (HRT) on coronary heart disease has been verified in epidemiologic studies. There are no data available on the rate of HRT use in Eastern Europe. Our goals were to study the rates of HRT in Eastern Europe, to compare them to those of the United States and Western Europe, as well as to compare their CV mortality rates.

METHODS

The use of HRT in Eastern Europe was calculated from sales records obtained from all pharmaceutical companies that ship HRT preparations to the given area. Data on HRT in Western countries were taken from the literature. Mortality rates were obtained from the World Health Organization.

RESULTS

The rate (mean +/- SD) of HRT in Eastern Europe was 2.88 +/- 2.67%, whereas 12.67 +/- 9.97% in Western Europe and the United States, p < .05. The cardiovascular mortality rate per 100,000 women older than 45 years in Eastern Europe was higher (1766 +/- 158.3) than in the Western countries (1155 +/- 164.1, p < .001).

CONCLUSIONS

The rate of HRT is markedly lower. whereas CV mortality rates are notably higher in Eastern Europe than in the United States or Western Europe. Because HRT seems to be underutilized in Eastern Europe, to increase its use might be an important tool to improve CV mortality rates. However, due to the risks associated with HRT, other measures to prevent coronary heart disease, such as smoking cessation programs, and other efforts should also be considered in Eastern Europe.

Urodynamic investigation of women operated on for genuine stress incontinence

Anterior colporrhaphy (Kelly-Stoeckel suture) was performed on 22 women suffering from grade-I or grade-II genuine stress incontinence. Urodynamic investigation was performed on every patient before surgery and 6 months postoperatively. 21 patients were cured and 1 patient improved. After operation the functional urethral length was increased by 28.8%, and urethrovesical pressure transmission was improved by 22.9%. Maximum urethral closure pressure decreased postoperatively by 21.1%. Pressure transmission was clearly improved by the surgical intervention and urinary continence was restored in spite of the fact that maximal urethral closure pressure decreased. Based on these results it is suggested to consider performing anterior colporrhaphy in cases of weak urethral closure pressure, because of the increased risk of worsening the complaints of these patients.

[Severe genital mycoplasma infection following cesarean section]

Authors report a serious case of post-caesarean delivery endometritis caused, probably exclusively, by genital mycoplasmas: Ureaplasma urealyticum and Mycoplasma hominis. The initial treatment of the patient with various penicillins, ceftriaxone, gentamicin, metronidazole and nystatine proved ineffective. Subsequently, as microbiological tests turned out positive for genital mycoplasmas, a therapy of doxycyclin was introduced and a full recovery could be attained. Authors' experience is consistent with the observation of American scientists that U. urealyticum is an important pathogen in post-caesarean delivery endometritis. Since the carriage of U. urealyticum in women is frequent in Hungary, it is suggested that microbiological investigations related to sectio caesarea always include tests for genital mycoplasmas.

[Systemic lupus erythematosus and pregnancy (effect of pre-conception hematologic disorders on fetal outcome)]

The aim of the study was to determine the fetal and neonatal outcomes of pregnancies conceived during the inactive phase of systemic lupus erythematosus (SLE). Fetal and neonatal outcomes in 75 pregnancies of 33 patients with SLE were analyzed. In 19 patients (57.6%) the SLE also had hematological autoimmune presentations prior to gestation, such as anemia, thrombopenia, garnulocytopenia, and antiphospholipid antibody and/or lupus anticoagulant (APA). Out of 75 pregnancies, 19 elective terminations were carried out because the disease was active or for non-medical reasons. The adverse fetal outcomes of those 56 pregnancies which occurred during the inactive phase were compared with those of the control patients. In SLE, the rates of spontaneous abortions (46.4%) and newborns with low (< 2500 gr) birthweight (36.7%) were found to increase roughly three times that of the controls and the perinatal fetal loss (16.7%) also increased significantly as compared with the control group (28.5 per thousand). APA noted at any time before pregnancy increased the low birthweight rate (75%) six fold and the perinatal loss (33.3%) more than ten fold but did not affect the rate of spontaneous abortions. Any kind of hemocytopenias without APA, noted before pregnancy did not worsen the fetal outcome in SLE. Neonatal lupus was diagnosed in 2 out of the 30 newborns. Our results suggest that among the hematologic manifestations of SLE presenting before pregnancy, APA can predict the high risks of low birthweight and perinatal fetal loss as opposed to hemocytopenias.

[Therapeutic importance of the diagnosis of Kallmann syndrome]

Hyposmia with hypogonadotropic hypogonadism was diagnosed as Kallmann syndrome in a 24 years old dizygotic female twin. This syndrome indicates the importance of smell in the sexual development through the progenitor cells in the olfactory placode because luteinizing-hormone-releasing hormone (LHRH) secreting cells of hypothalamus arise from these cells. In addition, substitution therapy may be successful in the treatment of the lack of secondary sex traits and primary amenorrhoea as the presented case demonstrated.

[Effect of preeclampsia on neonatal morbidity]

In this study the outcome of two groups of premature infants born by caesarean section were compared from 52 hypertensive mothers with severe pre-eclampsia and from 30 normotensive mothers. The indication of caesarean section in pre-eclampsia was: proteinuria (> 500 mg/24 h), high blood pressure (> 160/100 mmHg), abnormal cardiotocogram and abnormality in flowmetry (fetal distress). Every infant was premature as well as in the control group. Significantly smaller mean birthweight and longer nursing-time in neonatal intensive care unit (NICU) were found in the pre-eclamptic group. Neonatal illnesses and complications are more frequent in the pre-eclamptic group. The time of ventilation was also longer. There are more early neurological disorders in the pre-eclamptic group than in the control one. The authors can establish that pre-eclamptic toxemia increases the morbidity in the neonatal period. This is due to the chronic intrauterine fetal distress as well as the retardation.

[Insulin concentration in amniotic fluid in mid-term pregnancy]

Insulin concentrations of 284 amniotic fluid samples were assessed, obtained from pregnant women by genetic amniocentesis between the 16-18 gestational weeks. The indication of amniocentesis was either advanced maternal age (> 35 years) or high risk genetic history. The amniotic fluid insulin concentration (mean +/- SD) was found 3.8 +/- 3.0 microIU/ml. The insulin concentration in 4.3% of all pregnant women was higher than the mean value +2 SD (9.8 microIU/ml) which represents individual pathological value, characteristic for gestational diabetes. Our data suggest that one part of gestational diabetes might be detected between the 16-18 gestational weeks, therefore we propose an earlier screening as the usual one. At institutes where the possibility of genetic amniocentesis is given the determination of insulin level in amniotic fluid may be reasonable. We could analyze the outcome of 230 pregnancies analysed. A close correlation was found between the amniotic fluid insulin concentration and birthweights of female newborns. It could not found such correlation at male newborn. A more careful screening test for gestational diabetes should be performed at mothers with female fetuses.

[Monitoring of arterial pressure according to the "womb to tomb" program taking into account the human chronome]

The concept of "chronome" is discussed in this article. A lot of data of monitoring of arterial blood pressure in healthy people from babies till senile people are reported. This chronobiologic approach allows to optimize diagnosis in a group of people with elevated blood pressure and to exclude people with false positive and false negative diagnosis of hypertension. At the same time physicians can optimize therapy of hypertensive people with taking into account chronotherapy principle.

[Successful pregnancy after surgery for hypophyseal microadenoma]

The authors report on a successful conception, development of pregnancy and lasting symptom-free post-partum state of a young female patient who has been operated previously because of an hypophysis microadenoma. Delivery ended with Cesarean section. A living and mature newborn was born, with a weight of 2900 g.

Retrospective analysis of clinical data of normotensive and hypertensive pregnant women and their newborns

The medical history of 256 hypertensive and 263 normotensive pregnant women was analysed retrospectively. There was a negative correlation (P less than 0.01) between the maximal pretreatment diastolic blood pressure and the birth weight of newborns in the hypertensive group. The prevalence of a hypertensive family history, pyelonephritis, proteinuria, delivery by Caesarean section, fetal asphyxia during delivery and death of the newborn during delivery was significantly higher in the hypertensive group than in the normotensive one. The gestational age at delivery was shorter and the birth weight of the newborn was lower in the hypertensive women than in the normotensive women.

Candida guilliermondii var. guilliermondii infection in infertile women

The sera of 263 women--217 infertile and 46 pregnant--were examined by various serological methods (precipitation test, agglutination, indirect immunofluorescence) to detect Candida guilliermondii var. guilliermondii (C.g.) infection. The precipitation reaction was performed with extracellular C. guilliermondii antigen, the agglutination reaction was employed parallel with C. albicans. In the infertile group 122 (56.2%) proved to be C.g. positive, while in the fertile 11 women (23.9%) proved to be so, the level of significance being p less than 0.0001 between the two groups. A one-month ketoconazole treatment (one tablet, 200 mg/day) was adequate for eliminating the C.g. infection. In a few cases hystological examinations were also performed according to Gomori-Grocott and yeast cells could be detected in the stroma of the ovary. IgA, IgG, IgM, Gc-globulin, transferrin and ferritin determinations were carried out before and after the ketoconazole treatment, and there were significant differences in the IgM and transferrin levels between the infected and non-infected groups. The authors achieved 5 pregnancies of 56 treated women in 6 months.

[A microbiology clinic in outpatient gynecologic service]

The authors report on their experiences gained at the sexually transmitted disease clinic they established at the First Department of Obstetrics and Gynecology of Semmelweis Medical University. A total of 456 patients presenting with signs and symptoms of lower genital tract infection have been examined in one year. The investigation of patients included aerobic and anaerobic culture of vaginal bacteria, vaginal smear and the identification of sexually transmitted Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasmatales and Gardnerella vaginalis. The authors conclude that a sexually transmitted disease clinic is appropriate to contribute to the prevention of horizontal and vertical spread of the sexually transmitted bacterial infections.

Comparative effects of T-2 toxin and diacetoxyscirpenol on drug metabolizing enzymes in rat tissues

The effects of T-2 toxin and diacetoxyscirpenol on tissue drug-metabolizing enzymes in young male rats were compared. Mycotoxicoses were produced by daily oral administration of toxins at 1.0 mg/kg body weight for 1, 4 or 8 days. Many hepatic, renal and pulmonary oxidative and conjugative enzymes were measured in animals killed 24 hr following the last administration. The effects of the two trichothecene mycotoxins were generally similar. In liver the decrease in microsomal and cytosolic proteins paralleled the decline in total plasma proteins or the increase in plasma GOT activity. Hepatic microsomal cytochrome P-450 decreased in rats receiving trichothecenes for 8 days. This effect was more marked when aminopyrine, benzphetamine, ethylmorphine and ethoxycoumarin dealkylations or aniline and benzopyrene hydroxylations were measured. p-nitrophenol glucuronyltransferase activity was enhanced in animals receiving at least one administration of trichothecenes, whereas there was no change in conjugation to glutathione or acetate. In other tissues, there was no change in any renal enzymes whereas a significant rise in pulmonary monooxygenase was observed in T-2 toxin administered to rats for 4 or 8 days.

[Changes in estriol excretion in the urine and kidney function during Partusisten infusion]

In a random controlled trial the effects of a betamimetic infusion (Fenoterol 2 micrograms/min) on the estriol excretion and the renal function were analysed in 30 patients in the 28.-34. weeks of pregnancy. It was stated that the estriol excretion in urine during the Partusisten infusion significant decreases (from 663 micrograms/2 h to 376 micrograms/2 h, i.e. to 56%). The diuresis and the creatinine-clearance showed a significant diminishing too (from 218 ml/2 h to 154 ml/2 h and from 131 ml/min to 88 ml/min). The decrease of estriol excretion is caused on the one hand by the diminution of GFR, on the other by a direct effect of betamimetics on the kidney. From the results obtained in this study the following consequences can be drawn: 1. The determination of urinary estriol during tocolytic treatment is not a suitable method for the monitoring the fetoplacental unit. 2. Applying the tocolysis in an infusion a possible reduction of water intake and a strict control of water balance is of great importance. 3. The betamimetic therapy in patients having an impaired renal function can be applied only with great precaution.