Echinocytic transformation and aggregation of red cells in uremic patients.

Isolated rabbit lungs were perfused with washed and resuspended human red blood cells (RBCs) in the presence of drugs known to change the shape and deformability of RBCs. With sodium salicylate (0.5-2 g/l), which causes echinocytosis and increases RBC deformability, lung diffusing capacity for O2 (DLO2) increased by 21%. When chlorpromazine, which induces stomatocytosis and stiffens RBCs, was given (50 mg/l), DLO2 decreased by 18% under chlorpromazine. Comparative experiments with hemoglobin solutions did not reveal any effect of those two drugs either on DLO2 or on pulmonary arterial pressure, which indicates that the effects of sodium salicylate and chlorpromazine were due to changes in RBC shape and deformability. It is concluded that RBC shape and deformability affect pulmonary artery pressure and oxygen diffusing capacity, which may have an influence on oxygen transfer to tissue and hence be of clinical relevance.

Influence of radiation treatment on serum transferrin and tumor necrosis factor-alpha.

This study deals with the effect of radiation treatment (RT) on serum transferrin and tumor necrosis factor-alpha (TNF-alpha) in patients with malignant tumors. In 21 patients who received 36-60 Gy in 20 to 30 sessions of RT, serum transferrin and TNF-alpha were determined pre-RT, after 10 to 15 sessions (middle of RT) and after 20 to 30 sessions (end of RT). The values of serum transferrin pre-RT were significantly higher than those in the middle and at the end of RT (p < 0.001). The values of TNF-alpha were increased by RT and were significantly higher at the end of RT as compared to the pre-RT values (p < 0.05). The values of serum transferrin and TNF-alpha show a tendency to negative correlation, either as a whole or separately pre- and under-RT. However, no correlation was statistically significant.

Serum transferrin and ceruloplasmin in patients with cancer of the gastrointestinal and other systems.

Serum transferrin and ceruloplasmin were determined in 20 healthy subjects, 23 patients with cancer of the gastro-intestinal system (G.I.S) and 22 patients with other types of cancer. Serum transferrin in patients with cancer of the G.I.S. was significantly decreased in comparison to that of healthy subjects (p < 0.05) and to that of other cancer patients (p < 0.005), but no significant difference was found between the values of healthy subjects and those with other types of cancer. Serum ceruloplasmin was significantly increased in patients with cancer of the G.I.S. (p < 0.01) and other types (p < 0.05) in comparison to that of healthy subjects. No significant difference was found between patients with cancer of the G.I.S. and those with other cancer types. In conclusion, transferrin was significantly decreased in the serum of patients with cancer of the G.I.S. while ceruloplasmin was significantly increased in both groups of patients with G.I.S. and other types of cancer.

Biotin for diabetic peripheral neuropathy.

Biotin in high doses was given for 1-2 years to three diabetic patients suffering from severe diabetic peripheral neuropathy. Within 4-8 weeks there was a marked improvement in clinical and laboratory findings. It is suggested that in diabetes may exist a deficiency, inactivity or unavailability of Biotin, resulting in disordered activity of biotin-dependent enzyme, pyruvate carboxylase, leading to accumulation of pyruvate and/or depletion of aspartate, both of which play a significant role in nervous system metabolism. Based on our good results, regular biotin administration could be suggested for every diabetic patient for the prevention and management of peripheral neuropathy although extensive randomised clinical trials are required.

Structural changes and variations of uric acid in normal pregnancy.

Fifteen normal pregnant women were studied. Serial measurements of serum total, free and bound uric acid and their clearances were done in early (10-20 weeks), mid- (20-30 weeks) and advanced (30-40 weeks) pregnancy, and after delivery (4-5 weeks). The following was observed. 1. A decrease in early and mid-pregnancy of total and free uric acid (p less than 0.001). 2. A gradual increase from the early to advanced pregnancy of bound uric acid (p less than 0.001). 3. An increase in early and mid-pregnancy of total uric acid clearance and a similar but more pronounced increase of free uric acid clearance (p less than 0.001). These findings explain many differences in previous conflicting reports concerning the metabolic behavior of uric acid, and place future investigation thereof on a more promising basis in normal and abnormal pregnancy.

Hormonal and ultrasound characteristics of menstrual function during chronic hemodialysis and after successful renal transplantation.

The cycles of 11 renal transplant recipients (RTR), at least 24 months after stabilization of graft function and four hemodialyzed (HD) patients, menstruating regularly, were evaluated by concurrent and systematic determinations throughout the cycle of LH, FSH, estradiol, progesterone, testosterone, prolactin and SHBG and in the case of RTR also by ultrasound follow-up. Biphasic estradiol secretion, midcycle LH and FSH surge, duration of luteal phase, midluteal progesterone values and in the case of RTR, ultrasonic parameters were consistent with: (1) normal ovulatory cycles in five RTR; (2) ovulatory cycles with luteal phase deficiency in five RTR and two HD patients; (3) anovulatory cycles in one RTR and two HD patients. Thus, in HD patients only abnormal cycles of central etiology were found, while in RTR, luteal phase deficiency was a very common syndrome, in equal percentage with normal ovulatory cycles.

Changes of arterio-venous differences in pH and pCO2 by hemodialysis.

Normally the differences in arterial-venous pH (A-VpH) and veno-arterial pCO2 (V-ApCO2) are small and constant. This study deals with A-VpH and V-ApCO2 and their effect on arterial-venous saturation hemoglobin percentage (A-VSHb%) in uremic patients under hemodialysis (HD). In 17 uremic patients under HD with acetate, blood samples were collected anaerobically in heparinized syringes from artery (fistula) and vein (forearm without fistula) pre- and post-HD. In these samples pH, pCO2 and SHb% were determined and A-VpH, V-ApCO2 and A-VSHb% were estimated. Comparison between the values pre- and post-HD of A-VpH, V-ApCO2 and A-VSHb% shows that these three values were decreased significantly post-HD (p < 0.001). The correlation of all values (pre- and post-HD) of A-VpH and V-ApCO2 with that of A-VSHb% was significant and positive (r = 0.514 p < 0.01, r = 0.505 p < 0.01, respectively).

A cross-over study of a new low molecular weight heparin (Logiparin) in hemodialysis.

The safety and effectiveness of a low molecular weight heparin (LMWH) of 4500 +/- 1500 Daltons were evaluated in eight hemodialysis (HD) patients, in comparison with unfractionated heparin (UFH). In phase A of the study 3000 +/- 500 anti-factor Xa (AFXa) IU of LMWH were administered in bolus for the three consecutive HD sessions of a week. In phase B, 10000 +/- 2500 IU of UFH were administered to the same patients for the same time. Were observed no significant differences in hematocrit (Ht), platelets (Pt), fibronogen (FG) and prothrombin time (PT). Whole blood activated coagulation time (WBACT) was more prolonged with LMWH, 24 and 48 hours (start of next session) after administration (p < 0.05), and less prolonged at 5, 60, 120, 180, 240 min compared to UFH (p < 0.001). The activated partial thromboplastin time (APTT) and AFXa activity were more prolonged with UFH at 60 and 240 min (p < 0.001). The clinical effectiveness of the two preparations was similar as judged by thrombus formation and compression time. In conclusion, the present study found no real differences between LMWH and UFH, except for prolongation of WBACT 24 and 48 hours after the administration of LWMH. This probably indicates a cumulative effect of the LMWH and needs further investigation.

Serum changes of Ferroxidases and iron-binding capacity in pregnancy.

Serum changes of Ferroxidase I and II well as the total iron binding capacity (TIBC) and unsaturated iron binding capacity (UIBC) were measured throughout their gestation in 32 normal pregnant women. Significantly higher concentrations for all the above mentioned parameters were found as pregnancy advanced. Moreover, a significant and positive correlation between the weeks of gestation and a) serum Ferroxidase I (r:0.568 p < 0.001), d) serum Ferroxidase II (r:0.619 p < 0.001), c) serum TIBC (r:0.549 p < 0.01), and d) serum UIBC (r:0.424 p < 0.05) was found. The parallel serum changes of both ferroxidase with those of TIBC and UIBC are also shown in this study. The correlation of Ferroxidase I with TIBC (r:0.734 p < 0.001) and UIBC (r:0.536 p < 0.01) as that of Ferroxidase II with TIBC(r:0.634 p < 0.001) and UIBC (r:0.513 p < 0.01) was significant and positive. In conclusion, serum Ferroxidase I and II are progressively increased with serum TIBC and UIBC as pregnancy advances.

Changes of serum transferrin and ceruloplasmin after radiation therapy in women with cervical or uterine carcinoma.

Serum transferrin and ceruloplasmin were measured in 27 healthy women as well as in 21 women who received fractionated radiation therapy (RT) after undergoing surgery for cervical or uterine carcinoma. Although no significant difference in the mean values of transferrin was found between the healthy women and the patients before the initiation of RT, a significantly lower concentration of transferrin after the end of RT (p < 0.001) was observed in comparison to that of controls and of patients before RT. On the contrary, a significantly higher serum concentration of ceruloplasmin was found in patients before and after RT compared to that in healthy women (p < 0.001). The observed increase of ceruloplasmin after RT was not found to be significantly different from the mean value before RT. In conclusion serum transferrin is reduced by RT, while ceruloplasmin which is higher in patients before RT shows a tendency for increase following RT.

Sodium thiosulphate in the treatment of renal tubular acidosis I with nephrocalcinosis.

Nephrocalcinosis is a common feature in renal tubular acidosis I (RTA-I) and contributes to renal insufficiency. We describe a patient, 37 years old, with RTA-I, mild renal failure and extended nephrocalcinosis. His disease was diagnosed in age 28 and patient is under treatment with sodium bicarbonate, potassium gluconate and sodium thiosulphate for 9 years. By this treatment nephrocalcinosis and renal function have not been worsened and patient is without clinical symptoms.

The effect of successful renal transplantation on hormonal status of female recipients.

The pituitary, thyroid, and ovarian hormone levels were measured by enzyme and fluorescence polarization immunoassays in 18 women with successful renal transplants (recipients): 10 menstruating, mean age 34.7 years, mean time after transplantation (Tx) 112.00 months, mean SCr 130.60 mumol/L; and 8 menopausal, mean age 52.7 years, mean time after Tx 61.00 months, and mean SCr 119.00 mumol/L. Five women of the menstruating group conceived 7 times and gave birth to 4 healthy infants. The findings were compared to 30 age-matched healthy subjects (controls) and to 13 women under chronic hemodialysis (hemodialyzed patients): 2 menstruating, 24 and 36 years old, and 11 menopausal, mean age 59.4 years. Serum prolactin (PRL) showed a highly significant increase in hemodialyzed patients (p less than .0001) compared to controls. In recipients, PRL levels were significantly lower than in hemodialyzed patients, but higher than in controls (p less than .0001). LH and FSH were elevated in menstruating hemodialyzed patients (p less than .0001, p less than .02, respectively) and significantly high in menopausal hemodialyzed patients (p less than .02, p less than .01, respectively). In menstruating recipients, LH was also highly elevated (p less than .001), while FSH showed no significant difference from controls. In menopausal recipients the increase of LH was less prominent (p less than .02) but FSH was highly increased (p less than .001). T3, T4, and FTI were absolutely normal in recipients, while they were significantly lower than normal (p less than .0001) in hemodialyzed patients. Estradiol showed no significant difference in both groups of recipients, as well as in menopausal hemodialyzed patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Contrast media nephrotoxicity: comparison of diatrizoate, ioxaglate, and iohexol after intravenous and renal arterial administration.

In several studies in humans and animals it has been suggested that high osmolality and ionicity of contrast media are responsible for higher nephrotoxicity. To examine this suggestion, we evaluated the renal effects of three different contrast media--an ionic high osmolar, an ionic low osmolar, and a nonionic--following intravenous and renal arterial administration, in a population of 84 unselected, nondiabetic patients with adequate renal function. The results showed that the nephrotoxicity is minimal and equal for all three contrast media and for both routes of their administration, and it is concluded that in this category of patients the far higher cost of the newer low osmolar ionics and nonionics should be considered seriously in regard to nephrotoxicity.

Alterations in echinocyte transformation and erythrocyte sedimentation rate during hemodialysis.

In 18 uremic patients under regular hemodialysis (HD) with bicarbonate dialysate, the echinocytes and erythrocyte sedimentation rates (ESR) were determined in 4 blood samples collected from the arterial line at 0, 45, 120, and 240 min (end-HD) in one HD session by a bioincompatible dialyzer and in another by a biocompatible one. In the HD session by a bioincompatible dialyzer, the mean values (+/- SEM) of echinocytes (%) at 0, 45, 120, and 240 min were 8.89 +/- 1.15, 20.77 +/- 2.35, 7.39 +/- 1.1, 5.27 +/- 0.66 and of ESR (mm/h) were 65.00 +/- 6.26, 47.05 +/- 3.89, 66.72 +/- 6.00, 68.44 +/- 5.92, respectively. According to these findings, echinocytes show a transient significant increase at 45 min HD in comparison to those at 0 (p < 0.001), 120 (p < 0.001), and 240 (p < 0.001) min while ESR shows a transient significant decrease at 45 min HD compared with the rates at 0 (p < 0.05), 120 (p < 0.05) and 240 (p < 0.01) min. In the HD sessions with the biocompatible dialyzer, the mean values (+/- SEM) of echinocytes at the aforementioned 4 time points were 8.55 +/- 1.10, 17.05 +/- 2.40, 17.05 +/- 1.19, and 5.11 +/- 0.75%, and the ESR values were 60.89 +/- 6.08, 44.33 +/- 4.18, 62.94 +/- 6.55, and 65.61 +/- 6.13 mm/h, respectively. These values also show a transient significant increase of echinocytes at 45 min HD in comparison with those at 0 (p < 0.01), 120 (p < 0.01), and 240 (p < 0.001) min, with a parallel transient decrease of ESR at 45 min HD as compared to the ones at 0 (p < 0.05), 120 (p < 0.05), and 240 (p < 0.05) min. Although the echinocytosis at 45 min HD was more prominent in HD by the bioincompatible than by the biocompatible dialyzer, the comparison between these values indicates no significant difference in the echinocytes or the ESR. In conclusion, uremic patients receiving HD exhibit echinocytes, the percentage of which shows a transient increase at 45 min HD that returns to about baseline at 120 min HD. In parallel with the changes in echinocytes, the ESR shows an inverse change at 45 min HD which returns to baseline at 120 min HD.