Isospin Properties of Nuclear Pair Correlations from the Level Structure of the Self-Conjugate Nucleus ^{88}Ru

The low-lying energy spectrum of the extremely neutron-deficient self-conjugate (N=Z) nuclide _{44}^{88}Ru_{44} has been measured using the combination of the Advanced Gamma Tracking Array (AGATA) spectrometer, the NEDA and Neutron Wall neutron detector arrays, and the DIAMANT charged particle detector array. Excited states in ^{88}Ru were populated via the ^{54}Fe(^{36}Ar,2nγ)^{88}Ru^{*} fusion-evaporation reaction at the Grand Accélérateur National d'Ions Lourds (GANIL) accelerator complex. The observed γ-ray cascade is assigned to ^{88}Ru using clean prompt γ-γ-2-neutron coincidences in anticoincidence with the detection of charged particles, confirming and extending the previously assigned sequence of low-lying excited states. It is consistent with a moderately deformed rotating system exhibiting a band crossing at a rotational frequency that is significantly higher than standard theoretical predictions with isovector pairing, as well as observations in neighboring N>Z nuclides. The direct observation of such a "delayed" rotational alignment in a deformed N=Z nucleus is in agreement with theoretical predictions related to the presence of strong isoscalar neutron-proton pair correlations.

Urinary tract infections following renal transplantation: a single-center experience

BACKGROUND

Although infectious complications are the second most common cause of death after transplantation, there appears to be insufficient data regarding the impact of urinary tract infections (UTIs) on graft outcome and patient mortality and morbidity. In this study, we evaluated the incidence, risk factors, and long-term effects of UTIs on graft function.

METHOD

We performed a retrospective cohort study reviewing the medical records of patients who received a renal transplant at our center from January 1999 to December 2006. All UTIs, risk factors, long-term graft function, graft loss, and death were recorded. Outcomes among patients with UTIs were compared with those without UTIs.

RESULTS

Fifty-six of 136 patients (41.2%) had at least one UTI over a mean period of 38+/-25 months after transplantation. While there was a tendency toward graft loss among patients with UTIs (16.1% vs 6.3%, P=.08), there was no increased risk of death. The patients with UTIs displayed higher serum creatinine levels (1.7+/-1.4 vs 2.3+/-2.5 mg/dL, P=.07) compared to non-UTI patients in the long term. Upon multivariate analysis, female gender was the only risk factor for posttransplant UTIs. We did not determine any immunosuppressive drug as a risk factor for UTIs. The most frequent pathogens isolated in urine culture were Escherichia coli (n=72, 59.1%) and Klebsiella spp (n=21, 16.9%), and there were eight cases of bacteremia.

CONCLUSION

UTIs are a frequent problem after kidney transplantation. Female recipients are at greatest risk. In the long-term, UTIs should be considered as a potential risk for poorer graft outcomes.

Spectrophotometric determination of certain antidepressants in pharmaceutical preparations

Simple and reproducible spectrophotometric methods have been developed for determination of sertraline, fluoxetine, and venlafaxine in pharmaceutical preparations. The methods are based on the reactions between the studied drug substances and ion-pair agents (bromothymol blue, bromocresol green, or bromophenol blue) to produce yellow-colored ion-pair complexes in acidic buffers. After extracting in chloroform, the ion-pair complexes are spectrophotometrically determined at the optimum wavelength. Optimizations of the reaction conditions were carried out. Beer's law was obeyed within the concentration range from 1 to 15 microg/mL. The molar absorptivity, Sandell sensitivity, and detection and quantification limits were also determined. The developed methods were applied successfully for the determination of these drugs in some available commercial preparations. The results were compared statistically with those obtained from reported high-performance liquid chromatography methods.

Role of the antiangiogenetic drug paclitaxel on healing of intestinal anastomosis: an experimental study

BACKGROUND

The aim of intraperitoneal administration of antineoplastic agents is the prevention of the implantation of tumoral cells after surgical intervention or the treatment of peritoneal carcinomatosis. The efficiency of intraperitoneal administration of paclitaxel, which is also an antiangiogenetic agent, has been investigated recently. The aim of this experimental study was to evaluate, taking into consideration its antiangiogenetic properties, the effects of intraperitoneal paclitaxel on healing of end to end colonic anastomosis.

METHODS

42 rats were allocated to 2 main groups (n = 21 for each group) to be evaluated on postperative day 3 (group A) and postoperative day 7 (group B). Each of the two main groups was divided into 3 subgroups (7 rats each). These subgroups were determined as control and two treatment groups administered paclitaxel in a dose of 2.5 mg/kg and 3.5 mg/kg intraperitoneally. Anastomosed segments of colon were harvested on postoperative day 3 or 7 and evaluated to determine bursting pressure of anastomoses, hydroxyproline levels and neovascularization with CD-31.

RESULTS

In both groups, there were no significant differences between control and paclitaxel-treated groups with respect to bursting pressure. The level of hydroxyproline showed a significant decrease in all paclitaxel-treated groups compared with control groups (p = 0.001). Neovascularization was found to be decreased significantly on day 3 in the doses of paclitaxel 2.5 mg/kg (6.4 +/- 1.63) and 3.5 mg/kg (5.89 +/- 1.01) compared with control (8.02 +/- 0.88) (p = 0.029 and p = 0.005, respectively). There were no significant differences in neovascularization in either groups on postoperative day 7.

CONCLUSION

We suggest that intraperitoneal administration of paclitaxel during surgical procedure decreases the hydroxyproline content and neovessel formation that are necessary for healing of intestinal anastomosis.

A Sensitive HPLC Method for the Determination of Fluoxetine and Norfluoxetine in Human Plasma with Fluorescence Detection

A selective, sensitive, and precise HPLC method for the simultaneous determination of fluoxetine (FL) and its N-demethylated metabolite norfluoxetine (NFL) in human plasma has been developed. Following extraction with n-hexane, FL, NFL, and fluvoxamine (internal standard) were derivatized with 7-chloro-4-nitrobenzofurazan (NBD-Cl) under weakly alkaline conditions. NBD derivatives were extracted with chloroform after acidification and chromatographed on a reversed-phase column with gradient elution using acetonitrile and 0.1 mol/L nitric acid (pH 3) solution. Calibration curves were linear over the range of 1.0-100.0 ng/mL and 0.1-50.0 ng/mL for FL and NFL, respectively, with inter- and intraassay precision given by a relative standard deviation (RSD%) of less than 9.2%. The lower limits of quantification were 1.0 ng/mL for FL and 0.1 ng/mL for NFL. Recoveries of FL and NFL from plasma at three different concentrations were assessed. Average recovery was about 100% for both substances. The assay was applied to pharmacokinetic study in 2 healthy volunteers after a single oral administration of 40 mg of FL.

An HPLC method for the determination of atorvastatin and its impurities in bulk drug and tablets

A simple high-performance liquid chromatographic (HPLC) method was developed for the analysis of atorvastatin (AT) and its impurities in bulk drug and tablets. This method has shown good resolution for AT, desfluoro-atorvastatin (DFAT), diastereomer-atorvastatin (DSAT), unknown impurities and formulation excipients of tablets. A gradient reverse-phase HPLC assay was used with UV detection. Some solvent systems prepared using methanol or acetonitrile and water or buffer systems with different pH values were tested. Capacity factors of related substances were calculated at all tested systems. Best resolution has been determined using a Luna C18 column with acetonitrile-ammonium acetate buffer pH 4-tetrahydrofuran (THF) as mobile phase. Samples were eluted gradiently with the mobile phase at flowrate 1.0 ml min(-1) and detected at 248 nm. The proposed method was applied to the determination of impurities and were found to contain 0.057-0.081, 0.072-0.097, 0.608-0.664% of the DFAT, DSAT and total impurity, respectively.

Simultaneous determination of moexipril hydrochloride and hydrochlorothiazide in tablets by derivative spectrophotometric and high-performance liquid chromatographic methods

Two new simple and selective assay methods have been presented for the binary mixtures of moexipril hydrochloride (MOEX) and hydrochlorothiazide (HCTZ) in pharmaceutical formulations. The first method depends on second-derivative ultraviolet spectrophotometry with zero-crossing measurements at 215 and 234 nm for MOEX and HCTZ, respectively. The assay was linear over the concentration ranges 1.0-11.0 microg ml(-1) for MOEX and 0.5-9.0 microg ml(-1) for HCTZ. The determination limits for MOEX and HCTZ were found to be 1.0 and 0.5 microg ml(-1), respectively; while the detection limits were 0.2 microg ml(-1) for MOEX and 0.1 microg ml(-1) for HCTZ. The second method was based on isocratic reversed-phase liquid chromatography by using a mobile phase acetonitrile-20 mM phosphate buffer (pH 4.0) (50:50, v/v). Lisinopril was used as an internal standard (IS) and the substances were detected at 212 nm. The linearity range for both drugs was 0.5-12.0 microg ml(-1). The determination and detection limits were found to be 0.100 and 0.010 microg ml(-1) for MOEX and 0.025 and 0.005 microg ml(-1) for HCTZ, respectively. The proposed methods were successfully applied to the determination of these drugs in synthetic mixtures and commercially available tablets with a high percentage recovery, good accuracy and precision.

Analytical methods for the quantitative determination of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors in biological samples

Published analytical methods for the quantitative determinations of presently available five 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors ("statins"), lovastatin, simvastatin, pravastatin, fluvastatin and atorvastatin, are reviewed for therapeutic drug monitoring purpose in patients. Almost all assay reviewed are based on high-performance liquid chromatography or gas chromatography. Some purification steps (liquid-liquid extraction, solid-phase extraction, etc.) have been used before they are submitted to separation by chromatographic procedures and they are detected by various detection methods like UV, fluorescence and mass spectrometry. This review shows that most method may be used quantitative determination of statins in plasma and they are suitable for therapeutic drug monitoring purpose of these drugs.

A case of familial Mediterranean fever with amyloidosis as the first manifestation

We describe a 22-year-old Turkish woman with nephrotic syndrome who had a history of acute myelocytic leukemia. After careful clinical evaluation, the patient underwent a renal biopsy. Light microscopic examination showed deposition of Congo-positive material both in the mesangium and around the small vessels. By histochemical analyses, the deposited material was proved to be amyloid A (AA). Because the patient's history did not reveal any event that might explain the development of secondary amyloidosis, she was screened for mutations causing familial Mediterranean fever (FMF) and was found to be homozygous for the M694V mutation by denaturing gradient gel electrophoresis. We recommend that FMF-Phenotype II and the development of amyloid nephropathy, before or without other symptoms of FMF, should be kept in mind in the face of unexplained proteinuria/amyloidosis, especially in high-risk ethnic groups.

Polyglandular endocrine failure in a patient with amyloidosis secondary to familial Mediterranean fever

Familial Mediterranean fever (FMF) is 1 of the major causes of secondary amyloidosis. Renal involvement is the main clinical complication and it mostly presents with nephrotic syndrome and chronic renal failure. Although deposition of amyloid has been reported in several endocrine glands such as the adrenal, thyroid, and testes, clinically significant functional impairment is uncommon. Herein, we describe a patient in whom the diagnosis of FMF was based on molecular screening and who presented with recurrent hypoglycemic attacks and extensive amyloid deposition affecting various organ function including adrenal, thyroid, parathyroid, testes, intestinal system, and the heart.

Recognition of neurocognitive dysfunction in chronic hemodialysis patients

We sought to determine the prevalence, recognition, and consequences of mental impairment among chronic hemodialysis patients. We administered the Mini Mental Status Exam (MMSE), a brief validated method for assessing cognitive mental status that is commonly used by clinicians, to 84 patients from our dialysis units. To determine the clinical implications of mental impairment, we obtained Kt/V, albumin, protein catabolic rate, blood pressure, and hematocrit values. We found that 21% of subjects had mild mental impairment (MMSE 18 to 23) and that 11% had moderate-severe mental impairment (MMSE 0 to 17). We found no relationship between MMSE score and years on dialysis, Kt/V value, hematocrit value, or erythropoietin use. On univariate analysis, MMSE score was associated with albumin, protein catabolic rate, inter-dialytic weight gain, number of co-morbid conditions, number of hospitalizations. Outcomes on univariate analysis were further analyzed by multivariate analysis. There was an independent relationship between decrement in MMSE score and lower protein catabolic rate and increased hospitalization number and number of co-morbid conditions. Based on our findings, we recommend that clinicians routinely screen hemodialysis patients for mental impairment and target impaired patients for interventions to improve mental status and associated adverse outcomes.

Effect of fluid and sodium removal on mortality in peritoneal dialysis patients

Effect of fluid and sodium removal on mortality in peritoneal dialysis patients.

BACKGROUND

Adequacy of peritoneal dialysis (PD) traditionally is assessed using Kt/V(urea) and total creatinine clearance (TCC). However, this approach underestimates the importance of fluid and sodium removal. The aim of this study was to determine the effect of fluid and sodium removal on morbidity and mortality in PD patients.

METHODS

One hundred twenty-five PD patients were monitored for three years from the beginning of the treatment. The effects of demographic features, comorbidity, peritonitis rate, blood pressure, medications, blood biochemistry, peritoneal membrane transport characteristics, residual renal function (RRF), Kt/V(urea), TCC, normalized protein nitrogen appearance (nPNA), and removal of sodium and fluid on mortality were evaluated. Total and cardiovascular hospitalization rates were also recorded. A Cox proportional hazards model was used to determine factors predicting mortality.

RESULTS

In the Cox model, comorbidity, total sodium and fluid removals, hypertensive status, serum creatinine, and RRF were independent factors affecting survival. In contrast, Kt/V(urea) or TCC did not affect the adjusted survivals. Total sodium and fluid removal and hypertensive status also significantly influenced the hospitalization rate. Systolic and diastolic blood pressures were negatively correlated with total fluid (P < 0.001) and sodium removal (P < 0.001).

CONCLUSIONS

Together, these findings suggest that removal of sodium and fluid is a predictor of mortality in PD patients, whereas Kt/V(urea) and TCC are not factors. Adequate fluid and sodium balance is crucial for the management of patients on PD.

Remission of nephrotic syndrome after removal of localized Castleman's disease

Renal complications of Castleman's disease are uncommon. Among the various renal disorders, including mesangial proliferative glomerulonephritis, membranous glomerulonephritis, and minimal change disease, nephrotic syndrome attributable to renal amyloidosis is very rarely reported. We report a case of mixed type of localized Castleman's disease complicated with nephrotic syndrome. Renal biopsy was performed. The deposition of AA amyloidosis was shown. After the removal of two mesenteric lymphoid masses, the proteinuria was gradually decreased and disappeared. Renal biopsy was repeated after 14 months, and, despite complete remission of nephrotic syndrome, no regression in amyloid deposition was found.

The longitudinal effect of a single peritonitis episode on peritoneal membrane transport in CAPD patients

OBJECTIVE

To evaluate the longitudinal effect of a single peritonitis episode on peritoneal membrane transport.

DESIGN

A prospective longitudinal study.

SETTING

Department of nephrology in a university hospital.

PATIENTS

Eighteen continuous ambulatory peritoneal dialysis patients with peritonitis.

METHODS

Peritoneal transport for low, middle, and high molecular weight (MW) solutes was evaluated by peritoneal equilibration test (PET). The first PET was performed on the day following the diagnosis of peritonitis. The test was repeated at weeks 1, 2, 4, 12, and 24 and the results were compared to baseline PET data obtained before peritonitis. In addition, dialysate CA125 concentration and leukocyte count were measured.

RESULTS

During peritonitis there were significant increases in dialysate-to-plasma (D/P) ratios for all low, middle, and high MW solutes except potassium, and decreases in D4/D0 glucose ratio and ultrafiltration (UF) volume. Over the subsequent 2 weeks, solute transport gradually decreased to the baseline values then remained unchanged during follow-up. Although net UF volume demonstrated a similar course during the study, it did not completely return to the baseline value. No decrease in D/P sodium ratio was found at 60 minutes during the PET performed 24 weeks after peritonitis. The percent change in solute transport during peritonitis compared to baseline value was significantly correlated with a solute's MW (r = 0.776, p = 0.014). The slope of the regression line for D/P ratios versus MW, in double logarithmic scale, before peritonitis (-0.73 +/- 0.09) was steeper than the slope during peritonitis (-0.59 +/- 0.08).

CONCLUSIONS

These findings indicate that a single peritonitis episode does not permanently affect peritoneal solute transport. However, the loss of net UF that accompanies peritonitis is not completely recovered, probably due to impairment of transcellular water transport. The transport changes associated with peritonitis may be due to the combined effect of increased effective peritoneal surface area and intrinsic permeability. Our findings suggest that the latter mechanism seems to be more important.

Delivery of healthy infant during hemodialysis session

Acute renal failure secondary to bilateral ureteral obstruction in pregnancy is rare. We describe a case of acute renal failure secondary to bilateral ureteral obstruction. A 27 year-old woman at 35 weeks' gestation was referred to our hospital with a diagnosis of acute renal failure. The patient had been well until four days earlier, when she developed an abrupt anuria. She had been administrated excessive amounts of fluids, and unresponsive to parenteral furosemide. She had mild pitting oedema and an S3 gallop with crackles in the lungs. The uterus was enlarged to the expected size with a cervical dilatation of 2 cm in diameter. Her serum creatinine level was 7.0 mg/dl. Renal ultrasound showed bilateral hydronephrosis of severe degree. The patient was immediately hemodialyzed for advanced renal failure with hypervolemia, and a healthy infant was born at the third hour of the HD session without any complication. On the next day, her urine volume was 200 ml/day and serum creatinine level was 6.8 mg/dl. For this reason, the patient underwent cystoscopy and ureteral stents were inserted bilaterally. There was no evidence of ureteral stones or obstructive lesions. After the stenting, the urine volume increased and serum creatinine was decreased gradually to normal level at the seventh day of postpartum. Two weeks later ureteral stents were removed and both infant and patient were completely healthy. To the best of our knowledge, this is the first case of delivery of an infant during a haemodialysis session.

The impact of withdrawing ACE inhibitors on erythropoietin responsiveness and left ventricular hypertrophy in haemodialysis patients

BACKGROUND

Angiotensin-converting enzyme (ACE) inhibitors have the capability of decreasing left ventricular mass index (LVMI) in chronic haemodialysis (HD) patients. On the other hand, recent reports provide conflicting information regarding the impact of ACE inhibitors on responsiveness to recombinant human erythropoietin (rHuEpo), and there are no data about the effect of withdrawing ACE inhibitors both on rHuEpo response and LVMI in HD patients.

METHODS

ACE inhibitors were switched to another antihypertensive medication in 23 out of 68 patients in our HD unit who were receiving both rHuEpo and an ACE inhibitor for more than 1 year. Blood pressure at the pre- and post-dialysis phases, haematocrit levels and rHuEpo doses were determined at the end of the first and of the third years, and the LVMI was determined at the end of the third year. Statistical analyses were done in 15 patients in whom the study could be completed.

RESULTS

The mean (+/-SD) haematocrit level was increased from 26.3+6.4% to 29.8+/-6.3% at the first year (P<0.05), and to 29.4+/-6.5% at the third year (P<0.05 vs before), while the mean dose of rHuEpo was decreased from 208.3+/-99.0 UI/kg/week to 141.0+/-91.8 at the first year (P=0.01), and to 141.4+/-81.0 at the third year (P=0.01 vs before). Administration of rHuEpo had been stopped in two patients at the end of the first year. The mean blood pressure level and the mean LVMI were not changed (P>0.05 vs before). There were no significant changes in dialysis parameters, iron status, plasma renin activities, and levels of aldosterone, intact parathyroid hormone, aluminum and erythropoietin.

CONCLUSION

The findings of this small uncontrolled study indicate that withdrawal of ACE inhibitors in hypertensive chronic HD patients receiving rHuEpo may result in an increase in haematocrit level, and a decrease in dose of rHuEpo without any significant changes in the blood pressure level and LVMI. Controlled prospective studies are needed to clarify this issue.

Carotid intima-media thickness and ACE-gene polymorphism in hemodialysis patients

BACKGROUND

Carotid artery intima-media thickness (CIMT) has been used as a marker of atherosclerosis. An insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene is associated with various cardiovascular diseases. This study is aimed at evaluating early atherosclerotic involvement of carotid vessels and the relation to known risk factors and ACE gene I/D in hemodialysis (HD) patients.

METHODS

We measured CIMT using high-resolution B-mode ultrasonography in 51 non-diabetic HD patients and in 70 age- and sex-matched healthy controls, and evaluated the factors influencing CIMT. An I/D polymorphism in intron 16 of the gene coding for ACE was analysed by polymerase chain reaction.

RESULTS

The mean CIMT was significantly higher in HD patients than in healthy subjects (p<0.0001). In multiple regression analysis, independent risk factors for increased CIMT in HD patients were predialysis systolic blood pressure (p<0.001) and ACE D allele (p<0.01).

CONCLUSIONS

The present data suggest that CIMT is enlarged in HD patients. The ACE gene seems to be a candidate for influencing the CIMT and might therefore be involved in an HD patient's predisposition to the development of atherosclerosis.

The role of oxygen free radicals in acute renal failure complicating obstructive jaundice: an experimental study

Oxidant injury is considered to be an important mechanism in the pathophysiology of acute renal failure. It has been thought that decrease in extracellular and intracellular fluid and endotoxemia seen in obstructive jaundice may cause an increase in production of oxygen free radicals and impairment in antioxidant defense mechanism. This study is designed to investigate the possible role of oxidant injury in renal failure seen in jaundiced patients. In this study, 28 rats were divided into four groups: Control (C)(N = 7); Renal ischemia (RI)(N = 7); Obstructive jaundice+renal ischemia (OJ+RI)(N = 7); Obstructive jaundice (OJ)(N = 7). All groups were compared with each other according to renal failure findings and enzyme activities, such as Xanthine oxidase (XOD), Superoxide Dismutase (SOD) and Catalase in renal cortex and Glutathione Peroxidase (GSH-Px), in blood at 3rd day after ischemia and reperfusion. Renal failure findings monitored by blood urea and creatinine levels, seemed more evident in OJ+RI than RI group (p < 0.05). When compared with RI, in OJ+RI group, increase in XOD activity at 3rd day was statistically significant [0.259 +/- 0.01 U/g (tissue) and 0.362 +/- 0.03 U/g (tissue) respectively] (p < 0.05). SOD and GSH-Px activities of each ischemic group at 3rd day were decreased compared to non-ischemic groups. This fall was significant (p < 0.05). But there was no statistical difference between jaundiced and non-jaundiced groups. Alterations in catalase activities also had no statistical significance. These findings may suggest that the injury induced by oxygen free radicals at re-oxygenation of tissue after ischemia may also play a role in the pathogenesis of acute renal failure developed in obstructive jaundice.

Ultrastructural features of the bone response to a plasma-sprayed hydroxyapatite coating in sheep

The intentions of this study were to characterize the macroscopic, microscopic, and structural aspects of a plasma-sprayed implant and to thoroughly investigate bone tissue response after its implantation in sheep. Therefore, we used scanning electron microscopy, transmission electron microscopy (TEM), high-resolution TEM, X-ray diffraction, and energy-dispersive X-ray analyses. Assessment of the biomaterial prior to implantation showed a coating with irregular outlines and varying thickness, mainly consisting of hydroxyapatite (HA) covering a rough metallic implant core. Six months after insertion of the HA-coated Ti-6A1-4V implant, neither mechanical failure of the coating-substrate interface nor a significant loss of coating thickness was evident. However, an occasional lack of HA coating and phagocytosis of HA particles were noted. More generally, the implant was surrounded by well-mineralized bone investing the smallest cavities of the plasma-sprayed layer. Newly formed microcrystals with size, shape, and structure similar to those of bone apatite crystals were growing directly at the coating surface. These results suggest that the bone-bonding behavior of the considered grooved implant should provide satisfactory osseointegration and be suitable for fixed prostheses.

Relationship of ambulatory blood pressure monitoring data to echocardiographic findings in haemodialysis patients

BACKGROUND

The present study was performed to assess the value of ambulatory blood pressure monitoring (ABPM) in determining the adequacy of blood pressure (BP) control, and its relationship to echocardiographic findings in haemodialysis (HD) patients.

METHODS

We studied 40 non-diabetic adult patients who had been on regular HD treatment for a median duration of 43 months. Twenty-four-hour ABPM was performed using a non-invasive ABP monitor (Pressurescan, ERKA). Casual BP (cBP) was defined as the average of two measurements obtained at two HD sessions, one preceding and one following the ABP recordings, and was calculated for both the predialysis and postdialysis phases. Two-dimensional and M-mode echocardiography were performed in each patient to determine interventricular septal thickness (IVS), left ventricular posterior wall thickness (LVPW), left ventricular fractional shortening (FS), and left ventricular mass index (LVMI).

RESULTS

According to average 24-h BP levels, 50% of the patients had systolic hypertension (HT) (> 139 mmHg), and 72.5% had diastolic HT (> 87 mmHg), while only 25% had been diagnosed as HT by cBP measurements (P < 0.01 and P < 0.0001 respectively). Diurnal variation in BP was not present in about 80% of the patients. Echocardiography was normal in only four patients (10%). LVMI and LV wall thickness were correlated to ABPM data better than to cBP measurements. Using stepwise linear regression analysis, LVMI and IVS were positively correlated with systolic BP load (P < 0.0001 and P = 0.0001 respectively), and LVPW was positively correlated with night-time systolic BP level (P < 0.001).

CONCLUSIONS

ABPM is necessary to assess the adequacy of BP control, and is well correlated to end-organ damage of HT in HD patients.

An adverse reaction to local anaesthesia: report of a case

The safety of local anaesthetic agents is high but adverse reactions do occur. A common mistake among practitioners is misdiagnosing an adverse reaction to local anaesthesia as a hypersensitivity reaction. Some prospective dental patients are unable to undergo routine dental treatment because they have been mislabelled as allergic to local anaesthetics. This case report illustrates the need for practitioners to be sure of the signs and symptoms of potential adverse reactions and their appropriate management.

The role of acute-phase reactant proteins, carcinoembryonic antigen and CA 19-9 as a marker in the preoperative staging of colorectal cancer: a prospective clinical study

Acute-phase reactant proteins have been considered in searching for new biochemical tumor markers useful at initial diagnosis, staging and monitoring of colorectal cancer. In this study, we aimed to determine the role of acute-phase reactant proteins in combination with carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) at the preoperative staging of colorectal cancer. In 22 patients with cancers of the colon and rectum and in 9 control patients without cancer, the serum levels of CEA, CA 19-9, C-reactive protein (CRP), alpha 1-antitrypsin (AAT) and alpha 1-acid glycoprotein (AAG) were measured. While statistical analysis did not show significant correlations between serum CEA, AAT and CRP levels with the stage of disease, the significant correlations between serum CA 19-9 and AAG concentrations with the extent of cancer were detected (p < or = 0.0197 and p < or = 0.0378, respectively). Multivariate discriminant analysis gave a final prognostic model that included serum CA 19-9 and AAG levels with a significance of p < or = 0.0089. The Linear regression analysis also gave a form of (Stage = 0.04667 + 0.0077 x CA 19-9 + 0.0068 x - AAG) for staging. We considered that the serum AAG levels, in combination with serum CA 19-9 concentrations may have an important role in the preoperative staging of colorectal cancer.

The clinical correlations of serum tumor necrosis factor-alpha in acute leukemias: a predictor of response and relapse?

The clinical correlations of serum tumor necrosis factor alpha (TNF-alpha), a cytokine which can be released from leukemic blasts, has not been extensively studied. We have analyzed serum TNF-alpha in 20 ANLL, one CML-myeloblastic crisis, and 14 ALL adult patients by using a commercial ELISA kit. Sterile serum samples were taken on day 0, day 7, during remission and relapse with a mean follow-up period of 4.2 (1-19) months. After a median of 7 days following chemotherapy, serum TNF-alpha decreased both in responding ANLL (p = 0.004) and ALL (p > 0.05) but remained high in refractory leukemias. Values on day 7 were significantly different between responding and refractory patients in both ANLL (p = 0.0027) and ALL (p = 0.0099). At relapse, serum TNF-alpha increased starting at a median of 3 months preceding clinical symptoms in ANLL (p = 0.002). However, the relapse of ALL coincided with a slight increase which was not significant (p > 0.05). Together these findings indicate that serum TNF-alpha can be used as an early predictor of clinical response and relapse in ANLL.

Is sublingual nifedipine administration superior to oral administration in the active treatment of hypertension?

Nifedipine, a calcium-channel-blocking agent, was administered orally to 44 untreated patients (Group A) and sublingually to 51 untreated patients (Group B) who had a diastolic blood pressure more than 90 mm Hg and systolic blood pressure more than 140 mm Hg. The mean pretreatment systolic and diastolic blood pressure values were 185.3 +/- 26.0 and 115.1 +/- 13.4 mm Hg in Group A patients and 193.6 +/- 23.1 and 118.1 +/- 14.1 mm Hg in Group B patients respectively (p greater than 0.05). The hypotensive activity of nifedipine was observed at the tenth minute in both groups. Mean systolic and diastolic pressures were 168.9 +/- 23.7 and 101.9 +/- 14.2 mm Hg in Group A and 170.6 +/- 26.2 and 103.0 +/- 15.8 mm Hg in Group B, (p less than 0.001) Diastolic blood pressures dropped under 100 mm Hg at the twentieth minute in both groups. Maximal reduction of blood pressure was observed at the fortieth minute in both groups and the degree of reduction in blood pressure was also the same (mean systolic and diastolic blood pressures: 143.7 +/- 22.1 and 86.9 +/- 11.7 in Group A and 148.7 +/- 21.4 and 91.7 +/- 17.0 in Group B (p less than 0.05). The authors conclude that sublingual nifedipine administration is not superior to oral nifedipine administration (in capsular form) in the acute treatment of hypertension.

P-glycoprotein expression in refractory hematological neoplasms and circumvention of resistance with verapamil or cyclosporine A containing protocols

Either p-glycoprotein (pgp) or the encoding gene mdr1 expression has been reported to be correlated with multidrug resistance and poor treatment response. To investigate the incidence of pgp in refractory hematological neoplasms we analyzed malignant cells from 40 patients by an immunoperoxidase method using the monoclonal antibody C219. Pgp was positive in 75% of acute nonlymphoblastic leukemia (ANLL) and 50% of acute lymphoblastic leukemia (ALL). Pgp positivity was similarly distributed in both Tdt (-) and (+) ANLLs (64% versus 100%). Addition of Verapamil (VRP) (12 patients) or Cyclosporine A (CsA) (7 patients) to the previous chemotherapy protocol resulted in complete response in 7 (58%) and 3 (43%) of the patients respectively. Partial response was observed in one patient who received CsA. Both chemosensitizers were tolerated well with few reversible side effects. The preliminary results of this study have been presented in the 15th International Cancer Congress, August 1990 Hamburg, Germany.