[Monitoring of the heparin therapy during acute haemodialysis]. / Uberwachung der Heparintherapie bei Akutdialysen.

Anticoagulation during renal replacement therapy is recommended to avoid thrombosis of the filter devices and to maintain the blood flow. However, in the case of multiorgan failure and sepsis, an imminent bleeding complication in patients with acute renal failure may cause the need for an extracorporeal circulation without anticoagulation. The most common drug used in renal replacement therapy is the unfractionated heparin (UFH). With low molecular weight heparin (LMWH) good experiences are reported, too. Based on the level of evidence from clinical studies plasma measurement of heparin is indispensable for patients with renal insufficiency. The activated whole blood clotting time (ACT), the activated partial thromboplastin time (aPTT), and the determination of the anti-factor Xa activity (anti Xa) with chromogenic substrates are available as routine as well as as point-of-care tests. To monitor plasma levels of LMWH the anti Xa assay serves exclusively as a suitable monitoring. The anti Xa assay using chromogenic substrates is the most specific and valid one for monitoring heparin therapy. In lack of large controlled studies for the anticoagulation therapy and its monitoring with the anti Xa test in acute renal failure, the current experiences are based on the results of chronic renal replacement therapy.

Total potentially available nucleosides of human milk by stage of lactation.

Human milk-borne ribonucleotides reportedly have important physiological roles in breast-fed infants. Previous studies measured the free nucleotide content of human milk. To more fully evaluate the physiological capacity of nucleotides in human milk, we determined the monomeric and polymeric ribonucleotide and ribonucleoside content of milk pooled from 11 American women. Subsequently, we determined the total potentially available nucleosides (TPAN) of pooled and individual milk samples segregated by stage of lactation from 100 women in three European countries to test for effect of culture and diet. The methodology simulated in vivo digestion. Polymeric ribonucleotide (primarily RNA), monomeric ribonucleotide, and ribonucleoside-containing adducts (eg, uridine diphosphate hexose) were enzymatically hydrolyzed to their constituent ribonucleosides, the preferred form for absorption. Free and enzymatically liberated nucleosides were then measured by HPLC to yield the TPAN value. The mean (+/- SD) TPAN concentration of the 16 pooled European samples, derived from the 100 individual samples, was 189 +/- 70 mumol nucleoside/L human milk (range 82-402 mumol/L). The means (mumol/L human milk) of each nucleoside were 38 for uridine, 88 for cytidine, 31 for guanosine, and 32 for adenosine. These values included the contribution from the cellular portion of human milk. Only one of the 16 pooled samples contained a measurable amount of inosine (4 mumol/L). The potentially available ribonucleosides in the human milk samples were predominantly present as monomeric (36 +/- 10%) and polymeric (48 +/- 8%) nucleotides.(ABSTRACT TRUNCATED AT 250 WORDS)

Systolic function of the univentricular heart: comparison of the Simpson's rule with acoustic quantification.

BACKGROUND: Acoustic quantification (AQ) is a new method of obtaining real-time information about systolic ventricular function. This method establishes a ;blood-tissue interface' and computes an intraventricular blood volume in real time to derive a beat to beat instantaneous ejection fraction. AQ assessment of systolic function has been reported previously in patients with normal cardiotypes and varying degrees of myocardial dysfunction. OBJECTIVE: To determine the potential utility of AQ in patients with abnormal ventricular morphology, in whom systolic function may be difficult to measure by traditional methods. PATIENTS AND DESIGN: Seventeen children (nine females) ranging in age from five days to 18 years (mean 6.9 years) with univentricular left ventricle heart morphology underwent a prospective and comparative echocardiographic study of ventricular function with the use of AQ and manual planimetry (single plane Simpson's rule). Imaging was done during steady state without sedation. Routine scan planes were performed, followed by repeat scanning of the univentricle from the apical four-chamber view in the AQ mode. Subsequently, manual planimetry using Simpson's rule was performed from an online graphical analysis package to measure systolic and diastolic frames from the conventional replay images. These data were used to calculate ejection fraction using standards previously established. The results were then compared with real-time AQ results. SETTING: Tertiary care referral center. RESULTS: Scan time for the combined standard and AQ imaging averaged 45 mins (range 35 to 65 mins). Measured ejection fraction by AQ and manual planimetry were 44 +/- 11% and 46 +/- 10%, respectively. Statistical analysis by repeated measures ANOVA with Bonferroni/Dunn correction (F = 0.6, df = 1,32, P = 0.44) demonstrated significant agreement between AQ and manual planimetry with an intraclass correlation coefficient of 0.93. Bland-Altman analysis was used to provide a graphic display of the clinical significance of differences in the comparison of the two methods of measurement. CONCLUSIONS: These findings support the use of AQ for continuous online determination of indexes of systolic function for patients with univentricular left ventricle morphology. The variability in the morphology inherently present within this group of patients results in a wider variability of determined ejection fraction. Particular attention must be directed to the technical aspects of image acquisition and AQ application to ensure accuracy.

[Accuracy in the diagnosis of renal masses. Computed tomography, sonography, urography, angiography]. / Treffsicherheit in der Diagnostik renaler Raumforderungen.

One hundred and twelve renal masses, whose histology was confirmed at operation, as well as renal vein thrombosis and renal infiltration, were examined by urography, sonography, CT and angiography. In general the results showed good agreement. For the diagnosis of the type of tumour, its size, infiltration into the renal capsule, demonstration of regional lymph node metastases and infiltration into neighbouring organs and for the diagnosis of liver metastases, CT was superior to the other methods.

[Second line therapy for castration-resistant prostate cancer (CRPC)]. / Zweitlinientherapie beim kastrationsresistenten Prostatakarzinom (CRPC).

Every year in Germany approximately 12,000 men die of castration-resistant prostate cancer even though early detection using PSA-based diagnostics allows more patients to be diagnosed with a curable cancer. An established first line therapy at this stadium is docetaxel chemotherapy, given in a 3-week regimen, providing an overall survival advantage of 2 months. In 6-9 months, the patients treated primarily with docetaxel will progress to a docetaxel-insensitive phase which requires a secondary systemic therapy. Increasing understanding of molecular signal transduction has permitted a growing variety of promising modern drugs, including cabazitaxel, sipuleucel-T and abiraterone. More prospective clinical data will provide a large variety of different therapy combinations, sequence therapies or other therapy regimens particularly for selected subgroups of patients with castration-resistant prostate cancer.

Liquid chromatographic determination of vitamin D in milk and infant formula.

Vitamin D2 or vitamin D3 is determined by liquid chromatography (LC) in milk and infant formula. Vitamin D is extracted from the saponified sample, passed through an amino-cyano LC cleanup column to remove major interferences, and quantitated using normal phase LC. Within-day precision is 4.5% relative standard deviation (RSD); the overall method RSD (reflecting technician-to-technician, day-to-day, and within-day variability) is 7.7%. Overspike recoveries averaged 97% for milk, 98% for milk-based infant formula, and 93% for soy-based infant formula. The performance of the method is compared with that of the official AOAC vitamin D method (rat bioassay). The method is applicable to the determination of vitamin D in milk and in the major milk- and soy-based infant formulas available in the United States. The method can quantitate (but not distinguish) either vitamin D2 or vitamin D3. The method is applicable to milk and infant formula samples containing between 100 and 1500 IU vitamin D/L. Sample throughput is between 4 and 8 replicates per day.